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 for Windows 10

 

From: Ann Marie Kupinski
Sent: Thursday, November 19, 2020 6:10 PM
To: [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 for Windows 10

 

From: Ann Marie Kupinski
Sent: Wednesday, November 18, 2020 11:42 AM
To: [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

www.virtualveincenter.com

 

 

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?

<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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