To code correctly, you need to understand what an ABI is, which services qualify for 93922 or 93923, and which services you should include under E/M.
ABI: ABI involves using a Doppler ultrasound stethoscope to measure sound within the vessels at the ankle and elbow while inflating cuffs placed on the arms and legs. The tester divides the arm measurement by the ankle measurement. A result under 1 may point to artery blockage in the legs.
ABI plus: ABI alone does not qualify for 93922 or 93923. CPT® guidelines state that you may report ABI using those codes only when there is "simultaneous Doppler recording and analysis of bidirectional blood flow, volume plethysmography, or transcutaneous oxygen tension measurements." So you shouldn't report 93922 or 93923 unless documentation shows ABI plus one of those other tests.
E/M: The guidelines list two services you should include as part of the E/M vascular physical exam instead of using 93922 or 93923. Keep an eye out for use of a hand-held or other Doppler device that:
Doesn't allow the creation of hardcopy output (keep in mind that for these studies you'll see measurements and charts rather than imaging)
Produces a record that doesn't allow analysis of bidirectional vascular flow (for instance, the device can detect flow, but it can't determine the direction of the flow).
3. What Are the Specific NIPS Listed?
The code definitions list the following exams:
Bidirectional Doppler waveform recording and analysis
Transcutaneous oxygen measurements.
Question 2 discussed ABI services. Read on for more information on the other exams.
Bidirectional Doppler waveform analysis: Doppler ultrasound involves evaluating blood flow using reflected sound waves. If the cells are in motion, the sound changes. But the pitch doesn't change if there's no blood flow. As a result, the physician can measure Doppler velocity signals, also called waveforms, to locate vascular disease, according to The ACR Radiology Coding Source (January/February 2007).
Plethysmography: When the physician measures an organ or limb section's volume or flow rate, this is plethysmography. In other words, the test determines circulatory capacity of arteries, Schad says. Different types include air, impedance, strain gauge, and photo, CPT® Assistant (August 2009) states. For instance, you may see a pulsed volume recorder (PVR) for segmental air plethysmography using cuff pressure. Or for strain gauge plethysmography, staff members place an "elastic tube filled with an electro-conductive metal" around the patient's limb and evaluate blood flow based on the volume changes revealed by the specialized tube, states CPT® Assistant.
TCOM: Transcutaneous oxygen tension measurement may be abbreviated as TCOM, Schad notes. You also may see the term TcPO2. This service involves placing electrodes or sensors on the skin to identify the amount of oxygen carried to the skin by the arteries, explains Schad. This knowledge is important to the treating physician's medical decision making, she says. For instance, it may help in deciding the course for wound care for diabetic patients.
SO even there is no ABI but the case meets other requirements code for 93922