I actually emailed our CMS carrier. We're good. Raising your arms isn't any different than calf raises or walking which we also use. I am very comfortable calling these provocative maneuvers. I have also been asked to have patients walk stairs, ride bikes and do jumping jacks and lift weights... (we accomodate, but we always do our baseline since that is what our criteria supports. I don't have criteria for claudication that starts after 20 miles....


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-------- Original message --------
From: Steven Knight
Date:09/03/2014 9:52 PM (GMT-05:00)
To: [log in to unmask]
Subject: Re: ABI WITH EXERCISE

I don't believe that the provacative maneuvres mentioned in the 93923 CPT description refer to toe ups but to thoracic outlet testing. To be safe, I would stick to 93922 (single level).

Steve Knight BSc RVT RDCS
CVI Vascular Lab
Division of Vascular and Endovascular Surgery
Beth Israel Deaconess Medical Center
110 Francis Street, Ste 5B
Boston, MA
02215

Direct line: 617-632-9962
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________________________________________
From: UVM Flownet [[log in to unmask]] On Behalf Of Nancy Williams [[log in to unmask]]
Sent: Wednesday, September 03, 2014 3:24 PM
To: [log in to unmask]
Subject: Re: ABI WITH EXERCISE

93923 actually reads: 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)

We utilize the 93923 code for these ABIís with toe raises (provocative maneuvers) as well.

From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Audrey Fleming
Sent: Wednesday, September 03, 2014 3:13 PM
To: [log in to unmask]
Subject: Re: ABI WITH EXERCISE

Why would you charge a multi-level for a post exercise ABI?

From: Steve Flieder <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Wednesday, September 3, 2014 3:02 PM
Subject: Re: ABI WITH EXERCISE

93923....multi-level physiologic

Steve Flieder
Lifeline Vascular Access
Three Hawthorn Parkway
Vernon Hills, IL 60061

Phone:  617-510-2190
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From: UVM Flownet [mailto:[log in to unmask]] On Behalf Of Audrey Fleming
Sent: Wednesday, September 03, 2014 1:45 PM
To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: ABI WITH EXERCISE

There is no CPT code for toe-ups or hall walking.

From: Patricia Rudibaugh <[log in to unmask]<mailto:[log in to unmask]>>
To: [log in to unmask]<mailto:[log in to unmask]>
Sent: Wednesday, September 3, 2014 1:43 PM
Subject: ABI WITH EXERCISE

After seeing that CPT code 93924 cannot be used for hallway walking or "toe-up" exercise, only treadmill or hyperemia when completing an ABI with exericse test, does anyone still use the toe-up technique? If so, which CPT code is used?


Thanks in advance

Patty

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