Noninvasive peripheral arterial examinations performed to establish the level and/or degree of arterial occlusive disease are reasonable and necessary if significant signs and/or symptoms of possible limb ischemia are present and the patient is a candidate for invasive therapeutic procedures. Signs and/or symptoms of arterial occlusive disease include:
- Pain in the lower extremities defined as claudication (typically moderate to severe pain that causes a patient to stop activities and goes away with the cessation of activity),
- Rest pain usually associated with diminished or absent pulses which becomes worse when the limb is elevated,
- Color change (a red, blue or black color that doesn't go away).
"Vascular studies include patient care required to perform the studies, supervision of the studies and interpretation of study results with copies for patient records of hard copy output with analysis of all data, including bidirectional vascular flow or imaging when provided.
The use of a simple hand-held or other Doppler device that does not produce hard copy output, or that produces a record that does not permit analysis of bidirectional vascular flow, is considered to be part of the physical examination of the vascular system and is not separately reported." (2005 CPT, page 370, Non-invasive Vascular Diagnostic Studies)
Measurement of the ABI is considered fairly simple, conducted with a hand-held Doppler, and does not produce hard copy output. Therefore, since ABI does not meet the above requirements, NHIC Medicare Part B will not reimburse for ABI conducted alone. Medicare will reimburse when the ABI is part of a more extensive study.
Along with ABI, one or more of the following should be ordered:
- Doppler waveform analysis,
- Volume plethysmography,
- Transcutaneous oxygen tension measurement.
As defined in the "reasonable and necessary" clauses that are contained in Section 1862 (a)(1)(A) of Title XVIII, of the (SSA), it is expected that supportive documentation evidencing the condition and treatment will be documented in the medical record and be available upon request.
11/18/2006 - The description for CPT/HCPCS code 93922 was changed in group 1
History:1/1/08 - Due to the CMS Annual CPT/HCPCS update CPT code 93922 was updated (description change only)
11/7/06- Reviewed article and converted to one article # for both NCA and SCA.