How To Use CPT 93923 | Blood Flow & Blockages Evaluation In Upper Or Lower Extremities

CPT 93923 refers to complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, involving 3 or more levels or single level study with provocative functional maneuvers. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93923.

1. What is CPT 93923?

CPT 93923 is a medical procedure code used to describe complete bilateral noninvasive physiologic studies of upper or lower extremity arteries. These studies are performed to assess blood flow and detect blockages in the arteries of the arms and legs. The code is applicable when the procedure involves three or more levels or a single level study with provocative functional maneuvers.

2. 93923 CPT code description

The official description of CPT code 93923 is: “Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)”

3. Procedure

The 93923 procedure involves the following steps:

1. Placement of two or three pneumatic blood pressure cuffs on the arms or legs at various levels (proximal thigh, distal thigh, foot, ankle, calf, etc.).
2. Inflation of the cuffs above the normal systolic blood pressure and then deflation slowly.
3. Blood pressure measurements taken using a Doppler instrument.
4. Volume changes in the upper and lower extremity segment below the cuff are translated into pulsatile pressure, detected by a transducer, and displayed as a pressure pulse contour.
5. Several functional maneuvers are performed for complete bilateral study.

4. Qualifying circumstances

Patients eligible to receive CPT code 93923 services are those who require assessment of blood flow and detection of blockages in their upper or lower extremity arteries. This may include patients with symptoms of peripheral artery disease, such as leg pain, numbness, or weakness, or those with risk factors for arterial blockages, such as diabetes, high blood pressure, or a history of smoking.

5. When to use CPT code 93923

It is appropriate to bill the 93923 CPT code when a complete bilateral noninvasive physiologic study of upper or lower extremity arteries is performed, involving three or more levels or a single level study with provocative functional maneuvers. This code should be used when the procedure is necessary to assess blood flow and detect blockages in the arteries of the arms and legs.

6. Documentation requirements

To support a claim for CPT 93923, the following information needs to be documented:

• Patient’s medical history and symptoms indicating the need for the procedure.
• Physical examination findings related to the patient’s arterial health.
• Details of the procedure performed, including the levels at which cuffs were placed, blood pressure measurements, and any functional maneuvers used.
• Results of the procedure, including any detected blockages or abnormalities in blood flow.
• Interpretation of the results and any recommendations for further testing or treatment.

7. Billing guidelines

When billing for CPT code 93923, it is important to follow the appropriate guidelines and rules. This code is for a bilateral study, so do not append modifier 50 when the procedure is performed bilaterally. If only one arm or leg is available for study, report 93922 for a unilateral study when recording three or more levels or when performing provocative functional maneuvers. When both the upper and lower extremities are evaluated in the same setting, 93923 may be reported twice by adding modifier 59 to the second procedure.

8. Historical information

CPT 93923 was added to the Current Procedural Terminology system on January 1, 1994. There have been several updates to the code since its addition, with the most recent change occurring on January 1, 2012.

9. Similar codes to CPT 93923

Five similar codes to CPT 93923 and how they differentiate are:

1. CPT 93922: This code is used for unilateral noninvasive physiologic studies of upper or lower extremity arteries, involving three or more levels or single level study with provocative functional maneuvers.
2. CPT 93924: This code is used for complete bilateral noninvasive physiologic studies of lower extremity arteries, including exercise or reactive hyperemia.
3. CPT 93925: This code is used for duplex scan of lower extremity arteries, including imaging and Doppler waveform analysis.
4. CPT 93926: This code is used for a unilateral or limited study of lower extremity arteries, including imaging and Doppler waveform analysis.
5. CPT 93930: This code is used for duplex scan of upper extremity arteries, including imaging and Doppler waveform analysis.

10. Examples

Here are 10 detailed examples of CPT code 93923 procedures:

1. A patient with a history of smoking and leg pain undergoes a complete bilateral noninvasive physiologic study of lower extremity arteries at three levels.
2. A diabetic patient experiences numbness in their arms and undergoes a complete bilateral noninvasive physiologic study of upper extremity arteries with provocative functional maneuvers.
3. A patient with high blood pressure and leg weakness undergoes a complete bilateral noninvasive physiologic study of lower extremity arteries at four levels.
4. A patient with a history of peripheral artery disease undergoes a complete bilateral noninvasive physiologic study of upper extremity arteries at three levels and lower extremity arteries at three levels in the same setting.
5. A patient with intermittent claudication undergoes a complete bilateral noninvasive physiologic study of lower extremity arteries with postural provocative tests.
6. A patient with a history of deep vein thrombosis undergoes a complete bilateral noninvasive physiologic study of upper extremity arteries at three levels.
7. A patient with a history of atherosclerosis undergoes a complete bilateral noninvasive physiologic study of lower extremity arteries with reactive hyperemia.
8. A patient with a history of coronary artery disease undergoes a complete bilateral noninvasive physiologic study of upper extremity arteries with provocative functional maneuvers.
9. A patient with a history of stroke undergoes a complete bilateral noninvasive physiologic study of lower extremity arteries at three levels.
10. A patient with a history of vascular disease undergoes a complete bilateral noninvasive physiologic study of upper extremity arteries at four levels.