How To Use CPT Code 93922

CPT 93922 refers to limited bilateral noninvasive physiologic studies of upper or lower extremity arteries. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93922 procedures.

1. What is CPT 93922?

CPT 93922 is a medical billing code used for limited bilateral noninvasive physiologic studies of upper or lower extremity arteries. These studies are performed to examine the rate of blood flow and assess the presence of blockage in the extremity arteries. The code covers various tests, such as plethysmography, oxygen tension measurements, and Doppler waveform analysis.

2. 93922 CPT code description

The official description of CPT code 93922 is: Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels).

3. Procedure

1. The patient lies on an examination table.
2. One electrode is placed on the “control site” of the body, usually on the upper chest.
3. Two more electrodes are placed just around the wound site.
4. The physician may instruct the patient to breathe oxygen through a mask to increase the body’s oxygen level around the wound/ulcer.
5. Transcutaneous oxygen tension measurement is performed to identify if any peripheral vascular disease (PVD) is present.
6. Plethysmography devices are attached to the arms, legs, etc., to find out the circulatory capacity and blood flow of the extremity vessels, and to identify any blockage.
7. The medium of procedure can be air, water, etc.
8. All the procedures are non-invasive.
9. The entire procedure usually takes around 45 minutes to complete.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 93922 services are those experiencing symptoms or have a medical history that suggests the presence of peripheral vascular disease (PVD) or other arterial blockages in the upper or lower extremities. These symptoms may include pain, numbness, or weakness in the limbs, as well as non-healing wounds or ulcers.

5. When to use CPT code 93922

It is appropriate to bill the 93922 CPT code when a physician performs limited bilateral noninvasive physiologic studies of upper or lower extremity arteries to assess blood flow and the presence of arterial blockages. This code should be used when the physician performs one or more of the tests mentioned in the code description, such as ankle/brachial indices, Doppler waveform recording and analysis, volume plethysmography, or transcutaneous oxygen tension measurements.

6. Documentation requirements

To support a claim for CPT 93922, the following information should be documented in the patient’s medical record:

• Patient’s medical history and symptoms indicating the need for the procedure
• Physical examination findings
• Details of the procedure performed, including the type of test(s) conducted and the specific extremity arteries examined
• Results and interpretation of the test(s)
• Diagnosis or clinical impression based on the test results
• Recommended treatment plan or follow-up care

7. Billing guidelines

When billing for CPT code 93922, keep in mind the following guidelines and rules:

• No need to add modifier 50 for a bilateral study, as the descriptor describes a bilateral study.
• Use of a simple hand-held device is included in this procedure.
• When only one arm or leg is available for study, report 93922 with modifier 52 for a unilateral study when recording 1-2 levels.
• Report 93922 when recording 3 or more levels or performing provocative functional maneuvers.
• Report 93922 only once in the upper extremity(s) and/or once in the lower extremity(s).
• When both the upper and lower extremities are evaluated in the same setting, 93922 may be reported twice by adding modifier 59 to the second procedure.
• For transcutaneous visible light hyperspectral imaging measurement of oxyhemoglobin, deoxyhemoglobin, and tissue oxygenation, use 0631T.

8. Historical information

CPT 93922 was added to the Current Procedural Terminology system on January 1, 1994. There have been several updates to the code since its introduction, with the most recent change occurring on January 1, 2012.

9. Similar codes to CPT 93922

Five similar codes to CPT 93922 and how they differentiate are:

1. CPT 93923: This code is for complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, including more extensive testing and analysis than CPT 93922.
2. CPT 93924: This code is for noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing or pharmacologic intervention, with interpretation and report.
3. CPT 93925: This code is for duplex scanning of lower extremity arteries, including real-time B-mode imaging, spectral analysis, and color flow Doppler.
4. CPT 93926: This code is for duplex scanning of upper extremity arteries, including real-time B-mode imaging, spectral analysis, and color flow Doppler.
5. CPT 93930: This code is for duplex scanning of upper extremity arteries or arterial bypass grafts, including real-time B-mode imaging, spectral analysis, and color flow Doppler.

10. Examples

Here are 10 detailed examples of CPT code 93922 procedures:

1. A patient with a history of diabetes and non-healing foot ulcers undergoes ankle/brachial indices and transcutaneous oxygen tension measurements to assess for peripheral vascular disease.
2. A patient with intermittent claudication undergoes ankle/brachial indices and Doppler waveform recording and analysis at two levels in the lower extremities.
3. A patient with a history of smoking and leg pain undergoes ankle/brachial indices and volume plethysmography at two levels in the lower extremities.
4. A patient with suspected upper extremity arterial insufficiency undergoes ankle/brachial indices and Doppler waveform recording and analysis at two levels in the upper extremities.
5. A patient with Raynaud’s phenomenon undergoes ankle/brachial indices and volume plethysmography at two levels in the upper extremities.
6. A patient with a history of deep vein thrombosis undergoes ankle/brachial indices and transcutaneous oxygen tension measurements in the lower extremities.
7. A patient with a history of peripheral artery disease undergoes ankle/brachial indices and Doppler waveform recording and analysis at two levels in the lower extremities following a revascularization procedure.
8. A patient with a history of atherosclerosis and arm pain undergoes ankle/brachial indices and volume plethysmography at two levels in the upper extremities.
9. A patient with a history of hypertension and leg pain undergoes ankle/brachial indices and transcutaneous oxygen tension measurements in the lower extremities.
10. A patient with a history of coronary artery disease and intermittent claudication undergoes ankle/brachial indices and Doppler waveform recording and analysis at two levels in the lower extremities.