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I think the wording of the CPT codes has always been a bit vague.  I
always felt that a unilateral study - even if multiple levels were done -
warranted the 92922.

On Thu, Nov 19, 2020 at 7:21 PM Patricia Poe <[log in to unmask]> wrote:

> Meaning that you do a limited Allen Test, evaluating only by occluding the
> radial?  That seems like it is too abbreviated for 93923, but the code says
> single level with provocative maneuver.
>
>
>
> But 93922?
>
> 93922
>
> 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)
>
>
>
> I think it would be 93923
>
>
>
> Whatcha think?
>
>
>
> Sent from Mail <https://go.microsoft.com/fwlink/?LinkId=550986> for
> Windows 10
>
>
>
> *From: *Ann Marie Kupinski <[log in to unmask]>
> *Sent: *Thursday, November 19, 2020 6:10 PM
> *To: *[log in to unmask] <[log in to unmask]>
> *Subject: *Re: Radial Artery Studies
>
>
>
> You are right Tish!!  Sorry I was not aware of the provocative maneuver
> segment at the end of this code.  But we often only do our radial studies
> unilaterally, so I think we should still only use 93922.  What do you think?
>
>
>
> On Thu, Nov 19, 2020 at 5:42 PM Patricia Poe <[log in to unmask]> wrote:
>
> Allen Test, single level with maneuvers, is billed under 93023 if I’m
> interpreting the language correctly
>
> 93923
>
> 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)
>
>
>
>
>
>
>
>
>
> Sent from Mail
> <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.microsoft.com%2Ffwlink%2F%3FLinkId%3D550986&data=04%7C01%7C%7Cbe393014d0ad45e2ea3708d88ce05cfc%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637414242542757324%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=XtqhFFfQpDsEiSGBaqsTOHMQx8I1XBMFqgd9JBQhaPw%3D&reserved=0>
> for Windows 10
>
>
>
> *From: *Ann Marie Kupinski <[log in to unmask]>
> *Sent: *Wednesday, November 18, 2020 11:42 AM
> *To: *[log in to unmask] <[log in to unmask]>
> *Subject: *Re: Radial Artery Studies
>
>
>
> Just to clarify, the CPT code 93923 requires three levels or more levels
> of an extremity to be tested.  If you plan to do a palmar arch study you
> must include two additional levels (such as wrist and upper arm) to
> properly bill for the 93923.  If you only do the digits or just the digits
> and wrist, it would be CPT code 92922.
>
>
>
> Ann Marie
>
>
>
> On Wed, Nov 18, 2020 at 9:17 AM Michael Talcott <
> [log in to unmask]> wrote:
>
> I agree with Carolyn. A simple well documented Palmar Arch/Allen Test is
> very easy to do and very accurate. The Palmar Arch evaluation is
> reimbursable under cpt 93923.
>
>
>
>
>
>
>
> *From:* UVM Flownet <[log in to unmask]> *On Behalf Of *Carolyn
> Semrow
> *Sent:* Monday, November 16, 2020 12:14 AM
> *To:* [log in to unmask]
> *Subject:* Re: Radial Artery Studies
>
>
>
> you could do a simple Allen Test to determine if the interosseous ( median
> artery) is dominate or it contribution to digital perfusion as well as the
> radial & ulnar arteries contribution. It's easy to do,  takes all of 5-10
> minutes & is highly accurate.
>
>
>
> Carolyn
>
>  "A master, in the art of living, draws no sharp distinction between his
> work and his play, his labor and his leisure, his mind and his body, his
> education and his recreation. He hardly knows which is which. He simply
> pursues his vision of excellence through whatever he is doing and leaves
> others to determine if he is working or playing. To himself he always seems
> to be doing both." Francois-René Chateaubriand  (1768-1848)
>
>
>
>
>
> On Saturday, November 14, 2020, 08:39:21 AM CST, Bill Schroedter <
> [log in to unmask]> wrote:
>
>
>
>
>
> Interesting Brian. I am assuming the patient has no hand symptoms and no
> signs of embolization.
>
> I would tend to agree with you. While we know that some people have an
> incomplete palmar arch, it would seem like the most logical explanation
> would be some sort of anomaly of the arch.
>
>
>
> I will pose some additional questions. Could an interosseous or median
> artery supply segments of the arch without a direct or large vessel
> connection to it. Could the arch not have a direct large vessel connection
> to the digital arteries? While you were there, did you obtain finger
> pressures? Perhaps that could suggest an indirect pathway. Did you try to
> use duplex to image the arch? Difficult but perhaps that could provide some
> additional clues.
>
> Nonetheless, reluctance to harvest would seem prudent.
>
>
>
> Thanks for sharing.  Let us know.
>
>
>
> Bill
>
>
>
>
>
> William B Schroedter, BS, RVT, RPhS, FSVU
>
> 4120 Woodmere Park Blvd
>
> Suite 8B
>
> Venice, Florida  34293
>
> www.qualityvascular.com
> <https://eur02.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.qualityvascular.com%2F&data=04%7C01%7C%7Cbe393014d0ad45e2ea3708d88ce05cfc%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637414242542767314%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=ltPyNFQevxoiv79HuJlO84OMUTFYq12aTN9If43x%2Bh0%3D&reserved=0>
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> www.virtualveincenter.com
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>
>
>
>
> *From:* UVM Flownet <[log in to unmask]> *On Behalf Of *Brian Wirick
> *Sent:* Friday, November 13, 2020 8:20 PM
> *To:* [log in to unmask]
> *Subject:* Re: Radial Artery Studies
>
>
>
> I did have the thought about a big interosseous artery but in that case,
> you wouldn’t lose pulsatility at all, correct?
>
> Sent from my iPhone
>
>
>
> On Nov 13, 2020, at 14:05, Steve Knight <[log in to unmask]> wrote:
>
> 
>
> Perhaps an anomaly of the vasculature such as a persistent median artery
> <https://eur02.safelinks.protection.outlook.com/?url=https%3A%2F%2Fradsource.us%2Fpersistent-median-artery%2F&data=04%7C01%7C%7Cbe393014d0ad45e2ea3708d88ce05cfc%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637414242542797299%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=MzrSP1AH2PTnVkJnHeDool2vcy%2Bhiknt6EyjtK%2BF2ds%3D&reserved=0>
> ?
>
> <image.png>
>
>
>
>
>
> On Fri, Nov 13, 2020 at 12:37 PM Brian Wirick <
> [log in to unmask]> wrote:
>
> Had an interesting case this week:
> 43 year old for CABG needs radial harvesting.
>
> Arteries look normal. Allen's test is where things get confusing for us:
>
> right #1: flatline with radial compression. Decrease in pulsatility with
> ulnar compression
> right #2-5: flatline with radial compression. Flatline with ulnar
> compression.
>
>
> left digits: all flatline with radial compression. 2 and 3 show decrease
> in pulsatility with ulnar compression and 1,4,5 are normal with ulnar
> compression.
>
> Can anyone explain the results of the right hand allen's test?
>
> Thank you in advance,
> Brian
>
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> --
>
>        Steve Knight
>
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