Your question is indeed unorthodox.
Let's start in a logical order.
93923 states bilateral lower extremities arterial physiologic study
which can include all or a combination of the following,PVR, segmental
Doppler and segmental pressures, with documentation of such.
I do not recall anywhere in the CPT book where it would state anything
regarding which piece of equipment you are using. The only thing I am
almost certain of is that documentation is necessary, meaning that
charging for a one level pressure by taking only ABI without
documenting waveforms cannot be charged using 93922.
Therefore, I think that if you manage to be able to take segmental
pressures using your duplex AND you document waveforms by printing
pictures (or recording, or storing in PACS), then it seems that you
are within the boundary of the description.
As an advice though, tell the physicians you work with that using the
right equipment (mini lab for physiologic testing from Parks or
Unetixs) would probably give a great flexbility to obtain information
(since you would also have PPG, etc.) We all know we can use the
handle of a screwdriver to hit a nail, but using a hammer makes the
task so much easier to perform!
Quoting "G. Bell, RVT" <[log in to unmask]>:
> Nathalie, thanks for your response. I wasn't referring to actual LE
> art scanning. What I am wondering about is the documenting of
> waveforms and taking pressures using your duplex vs. using a
> separate piece of equipment to perform essentially the same
> functions. I have in the past used the duplex to obtain pressures,
> as, at one point, our technical director was asking all of us to do
> so--which no one else did, but I got quite comfortable with it.
> This was also in a setting where we did not do PVRs, so that
> component of the physiological study was not missed anyway--and all
> of the surgeons and medical director seemed quite satisfied with our
> results minus this component--their choice, not mine. Somewhere in
> the last several years, I thought I heard that Medicare would only
> reimburse if the physiological study was performed using a separate
> machine designed for physiologic studies only.
> There were actually times when I could not find the vessel using the
> pencil probe because the flow state was so slow--less than 10
> cm/sec, but I could, in fact, find it using the duplex to locate the
> vessel and document waveform/obtain pressures. My initial
> impression using the Doppler would have been "occluded" when it was
> So, to try to clarify my question, would Medicare reimburse for a
> 93923 performed using a duplex machine to document/print the
> waveforms and obtain the pressures?
> Also, I searched the archives and came up with information stating
> that a 93923 is defined as either of these:
> 1) ABIs (only single level pressures and waves) at rest AND must
> include provocative maneuvers, or
> 2) Full segmental pressures and waveforms from multiple levels with
> OR without provocative maneuvers.
> Is this correct?
> I'm sorry to maybe seem obtuse, but these are very important
> questions for me at this time. If not able to answer, can anyone
> direct me to an accurate information source?
> Thanks, GB
> -------------- Original message --------------
> From: [log in to unmask]
>> 93923 is the CPT code for complete physiologic testing of lower
>> extremities without exercise... So I am not even sure how you would
>> perform that with a duplex!!! unless you take blood pressure while
>> scanning the vessels which is really unpractical... It usually
>> includes segmental pressures, PVR and Doppler waveforms analysis (the
>> only thing you can really do with the Duplex). If you really are just
>> scanning the arterial system there are other codes to use like 93925
>> and 93926.
>> As for the exercise or other maneuvers, you need to use 93924 for
>> lower extremities which include the tests at rest AND post exercise.
>> Hope this helped.
>> Quoting "G. Bell, RVT" :
>> > Colleagues,
>> > Trying to resolve some disputes:
>> > 1) In CA, is a 93923 Medicare reimbursable if performed on an
>> imager, or must
>> > it be performed on separate equipment with analog waveforms?
>> > 2) Additionally, to be reimbursed must it include provocative maneuvers
>> > (unless contraindicated?)
>> > 3) From a diagnostic viewpoint, is it ever unnecessary to perform
>> > maneuvers? When would you NOT do them?
>> > Or, can someone direct me to information regarding #s 1 and 2?
>> > Thanks in advance.
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