CPT 93922 describes bilateral studies of the physiologic response of the extremity arteries and serves as a study of blood flow and/or vascular related disease. Coding CPT 93922 appropriately outlines the need to fully understand the CPT code’s indication, the specific code’s relation to other codes, the appropriate use of modifiers, and the level of documentation required. In order to promote patient care, CPT 93922 coding must take into account the appropriate index, the rendering guidelines on the CPT code, denial coding, and bundle coding. This will allow for appropriate reimbursement on patient care and physician rendered services.
Medical coding must be done correctly to get the business paid and stay within guidelines set by payers. One of the codes that come up in vascular testing is CPT 93922.This code applies to non-invasive physiologic studies of the extremity arteries which is a key component of the evaluation of peripheral arterial disease (PAD) and other related vascular conditions. Understanding the specifics related to the CPT 93922 including the associated documentation and billing, can assist providers in minimizing the risk of denials and maximizing revenue. This article is designed to assist the reader in understanding CPT 93922, its definition, its clinical applications, and associated billing, documentation, and reimbursement issues.
What Is CPT Code 93922?
CPT code 93922 describes limited bilateral non-invasive physiologic study of the extremity arteries. This study entails non imaging techniques to assess blood flow in the arms or legs, the most common of which are Doppler waveform analysis or segmental pressures. This study is primarily a screening study and is a follow up assessment to ascertain blood flow to the arteries and to rule out any blockages or circulatory problems.
Comparatively, CPT 93922 is one of the more basic studies of vascularity. More detailed studies would look at more levels or measurements than the CPT 93922 code. This test is usually done in outpatient clinics, doctors’ offices, or the outpatient departments of a hospital
Clinical Purpose of CPT 93922
The main goal of CPT 93922 is to look at the blood circulation in the arteries of a patient. This is done when the patient shows signs that indicate some vascular problems, such as leg pain while walking (claudication), numbness, extremities that feel cold, slow to heal wounds, or see pulses that are not strong.
The results of the studies are used to look for the first signs of peripheral vascular disease, look at the progression of an existing vascular problem, and assess the effectiveness of prior interventions, and decide if more tests are warranted.This is usually the primary examination done because it avoids making any cuts and can be done relatively quickly.
Difference Between CPT 93922 and Related Codes
In order to do proper billing and coding, one needs to understand how CPT 93922 differentiates from its comparable codes, especially those that pertain to vascular testing. CPT 93922 is a limited bilateral study of the physiology of the arteries of the extremities. CPT 93923 would apply to complete bilateral physiology studies and CPT 93924 would apply to studies done both at rest and post exercise. Each of these studies differ for the level of study done and for the complexity of that study. CPT 93922 would be appropriate and sufficient for studies that include a limited number of measurements. For studies that include a greater amount of responses, then a different CPT code would have to be used.
Indications for Using CPT 93922
CPT 93922 for vascular studies is used because there is some level of clinical suspicion for disease of the arteries and or there is a need to monitor a clinical condition, including but not limited to arterial disease, atherosclerosis of the extremities, diabetes that has vascular complications, chronic ischemia of the limbs, and post vascular intervention. There must be a diagnosis that justifies the medical necessity of the study that is linked to the appropriate diagnosis code.
Components of the CPT 93922 Procedure
Doppler waveform analysis, measurements, and computations of the Ankle Brachial Index (ABI) or comparable ratios are all part of the CPT 93922 process. Evaluating arterial blood flow and identifying areas of less blood flow are what these assessments are designed to do. Because there are limitations to the study, not all levels or segments of the limbs are examined.
Billing Guidelines for CPT 93922
CPT 93922 billing must be done according to the payer, and the country’s billing guidelines must be followed. CPT 93922, which involves a bilateral, limited study, must be considered a single report per session. It is not supposed to be billed per extremity, unless the payer has a rule for unilateral billings using certain mods.
CPT 93922 also cannot be billed for the same diagnosed region or the same date of service paired with a more extensive vascular testing code unless there is a mod and the clinical necessity is documented.Finally, if the study involved one extremity, certain payers prefer the application of mod -52 (Reduced Services) or -RT/-LT per their guidelines.
Modifier Usage with CPT 93922
Modifiers can be used with the billing of CPT 93922 with some level of necessity. For example, -26 is applicable when only the professional interpretation is billed. -TC is for the technical component. -52 is used when a bilateral study is only partially done. -59 is for separate, distinct vascular procedures. Make sure to follow the guidelines for the payer before using a modifier.
Documentation Requirements
For CPT 93922, billing requires a lot of detailed documentation. In addition to the physician’s signature and date, the patient’s medical record must include the patient’s clinical indications and symptoms, the name of the study, the methods of the study (e.g., ABI, Doppler, segmental pressures), Any results and interpretations of the study must also be included. Why a limited study was done instead of a complete study must also be justified in a clear manner.
Medical Necessity and Diagnosis Coding
In order for the CPT 93922 to be processed, there must be a diagnosis code that justifies the test for the claim to be processed. For peripheral vascular disease, there are several applicable ICD-10 codes, as well as the codes for Limb ischemia and claudication. The diagnosis must appropriately document what the patient was experiencing at the time of service. Studies with only elevated risk factors or no symptoms at all documented will be considered to be at a screening level and will likely not be reimbursed.
Reimbursement for CPT 93922
Reimbursement for CPT 93922 will differ from payer to payer, location, and service. Typically, regardless of the case, limited studies will result in less reimbursement than complete studies due to the complexity involved. Medicare and some commercial payers publish fee schedules for their respective allowed amounts. Practices should check them often for estimated revenue cycles to manage their revenue cycles more efficiently.
Factors That Affect Reimbursement
The services you provide, proper use of modifiers, accurate diagnosis coding, and payer policies, determine how much reimbursement you receive for billing CPT Code 93922. Incorrect modifiers, missing, incorrect, or inadequate documentation, or coding will lead to a denial or a decrease in reimbursement. Therefore, such documentation is critical in securing reimbursement.
Common Denials and How to Avoid Them
Insufficient justification or denial, incorrect modifier usage, contradictory coding/billing, and insufficient supporting documentation are the most frequent reasons for claim denials for CPT 93922. It is advised that, in order to defend the claim for services rendered, health practices increase the level of supporting documentation, review coding policies, and implement periodic internal audits to reduce the possibility of this happening.
Office vs. Facility Billing Considerations
In an office, providers usually bill both the technical and professional components of CPT 93922 as a package.In the context of hospital outpatient services though, the bills are typically split in such a way that the hospital bills for the technical, and the physician bills for the professional. These distinctions matter for claim and reimbursement.
Compliance and Audit Preparedness
Due to the frequent auditing of vascular studies, it is necessary to adopt more meticulous compliance practices to mitigate potential inaccuracies and the consequent financial risk. This supports the need for coding practices current to the CPT and payer policies, regular training for the clinical and billing teams, and more frequent risk mitigation internal audits of the clinical documentation.
Best Practices for Accurate CPT 93922 Coding
Healthcare providers and billing teams can improve code accuracy and reduce denials by first identifying how detailed a vascular study was performed and if this study justifies the vascular CPT code. Also, confirming the medical necessity of the study and documenting the patient’s rationale in the symptoms, along with the payer associated with the study, is equally important.
Role of CPT 93922 in Patient Care
CPT 93922 entails constructive components in the billing which promotes the provision of quality patient care by helping the physician evaluate, quickly and at low cost, the arterial blood flow. If the clinician is able to detect the problem early, he may take the necessary actions, suggest relevant adjustments in the patient’s habits, and prevent the problem from getting worse. This will help the patient, both functionally and in terms of his overall quality of life.
Future Trends in Vascular Diagnostic Coding
Technological advancements have made more diagnostic tools non-invasive, sophisticated, and more accessible. In vascular diagnostics, we may see more advanced Doppler systems, automated waveform analysis, and AI-assisted interpretation, as well as portable vascular testing devices. These innovations may change how physiologic studies are conducted and reported.
Conclusion
One of the most sought after and valuable codes is CPT 93922 which reports limited bilateral non-invasive physiologic studies of the extremity arteries. Using this code correctly requires an understanding of the definition, the situations in which the code may be used, the documentation and billing requirements. Healthcare organizations encounter the most robust reimbursement, the fewest denials, and the highest standards of patient care by staying current on the policies of the payers and following the best practices.
Make An Appintment With A2ZFAQs
CPT code 93922 is used to describe a study of blood flow of the extremities and is used to evaluate for the presence of arterial disease by using a bilateral non-invasive physiological study of the extremity arteries.
CPT 93922 should be used when a study is limited, while CPT 93923 is used for full bilateral physiological studies of the arteries.
CPT 93922 can be billed with the modifiers 26, TC, 52, and 59; these modifiers may be used depending on the service performed and used by the payer.
The documentation should contain the following: the medical necessity, the type of test that is being performed, the method used, the results, the interpretation, the signature of the physician, etc.
The absence of medical necessity, the use of an incorrect modifier, and the incomplete documentation are some of the reasons claims may be denied.