The ABI Blunder That Blows Away $120 Per Cardiology Claim
Posted on 17. Feb, 2009 by Editor in Hot Coding Topics
5 essentials help keep your noninvasive study codes watertight.
Your practice may use ankle/brachial indices (ABIs) to help diagnose some of the 8 million Americans who have peripheral arterial disease. But if you miss CPT’s guidance on hardcopies for noninvasive arterial studies, you could be headed for trouble.
Just posted: The agenda & speakers for our 2009 cardiology coding conference!
Work your way through these 5 important rules to keep your accuracy rate at its best.
1. Single vs. Multiple Matters
Take a close look at the descriptors for these noninvasive arterial study codes:
• 93922 - Non-invasive physiologic studies of upper or lower extremity arteries, single level, bilateral (e.g., ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement)
• 93923 – Non-invasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (e.g., segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia).
The key distinction is that you should use 93922 for a limited exam performed at one level of each leg, for example, and 93923 for an exam of multiple levels of each leg, points out Stacie L. Buck, RHIA, CCS-P, LHRM, RCC, CIC, president and senior consultant of RadRx in Stuart, Fla.
‘Segmental’ tip: For 93923, you may run across the terms “multiple,” “various,” or “segmental.” You may even hear the equipment used to perform the studies referred to as “segmental machines,” says Bruce W. Hammond, CRA, CNMT, executive vice president of Diagnostic Health Services, which serves more than a dozen states.
2. Arms, Legs, or Both Required?
If the cardiologist performs complete multiple-level bilateral studies of the arms and legs, coders often wonder whether one or two units are appropriate. Solution: You should report two...
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Debbie Walsh
12. Mar, 2009
This article on ABI Blunders is very useful and answered some of the questions I needed to research. Thank you!
Tresa Boyd
08. Dec, 2009
discussion in my group, if a family practice provider checks bilateral ankle and elbow with hand held device and hand writes blood pressure results on a printed diagram, can they charge for that in addition to the E/M code? If so, what CPT Code can they bill?
cindy
20. Apr, 2010
do you have to be a registered tech to perform and get paid for ABI?
Robert Ross
24. May, 2010
Could tip toe (active pedal plantarflexion) exercise testing be considered as a “postural provocative test measurements” or “provocative functional maneuvers”?
http://www.radiologytoday.net/archive/rt061509p8.shtml
http://www.audioeducator.com/uploads/productfiles/1690.pdf
Thank you.
Robert R. Ross, PA-C
Triad Diagnostic Technologies, LLC
Point of Care-Peripheral Vascular/Peripheral Neuropathy Studies
President-Clinical Affairs,
Medical Education and Research Development
39625 Lewis, Suite 200
Novi, MI 48377
248-679-1710 Office
Fax: 248-406-5046
Cellular: 248 819 2788
E-mail: bobross@earthlink.net
June 15, 2009
The Lowdown on Extremity Studies
By Laureen Jandroep, OTR, CPC-EMS, CPC-H, RCC
Radiology Today
Vol. 10 No. 12 P. 8
CPT codes 93922 and 93923 are assigned for bilateral upper or lower extremity arterial assessments to check blood flow in relation to a blockage. These are typically performed to establish the level and/or degree of arterial occlusive disease. There are no “pictures” or images of the study. In looking at the code descriptions closely, you’ll see that they are both bilateral, but 93923 would cover multiple levels, also referred to as “segments.”
• 93922 — Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral (eg, ankle/brachial indices, Doppler waveform analysis, volume plethysmography, transcutaneous oxygen tension measurement).
• 93923 — Noninvasive physiologic studies of upper or lower extremity arteries, multiple levels or with provocative functional maneuvers, complete bilateral study (eg, segmental blood pressure measurements, segmental Doppler waveform analysis, segmental volume plethysmography, segmental transcutaneous oxygen tension measurements, measurements with postural provocative tests, measurements with reactive hyperemia).
Additional documentation of one of the following would support 93923:
• provocative functional maneuvers;
• postural provocative test measurements; or
• reactive hyperemia measurements.
If none of the above are documented, it’s most likely that the procedure should be coded to 93922.
Because the code descriptions are stated as bilateral exams, use modifier 52 for reduced services if the study is only done on one side. Additionally, because the CPT description states upper or lower extremity, you can report two units of 93922/93923 if both upper and lower studies are performed.
So where is CPT code 93924 in all this? 93924 signals non-invasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, complete bilateral study. 93924 is the same as 93923, with the addition of bilateral lower extremity exercise such as treadmill stress.
Duplex Scans
Duplex Doppler ultrasound uses standard ultrasound methods to produce an image of a blood vessel and the surrounding organs. In addition, a computer converts the Doppler sounds into a graph that provides information about the speed and direction of blood flow through the blood vessel being evaluated.
It’s important to note that handheld Dopplers, wherein the physician just listens and there is no hard copy output for evaluation of bidirectional blood flow, are not reportable by these codes. Those services are usually considered part of the evaluation and management service.
Duplex scans require the three pairs of codes as follows:
• Lower extremity arterial: 93925 — Duplex scan of lower extremity arteries or arterial bypass grafts, complete bilateral study; 93926 — Duplex scan of lower extremity arteries or arterial bypass grafts, unilateral or limited study.
• Upper extremity arterial: 93930 — Duplex scan of upper extremity arteries or arterial bypass grafts, complete bilateral study; 93931 — Duplex scan of upper extremity arteries or arterial bypass grafts, unilateral or limited study.
• Upper or lower extremity venous: 93970 — Duplex scan of extremity veins including responses to compression and other maneuvers, complete bilateral study; 93971 — Duplex scan of extremity veins including responses to compression and other maneuvers, unilateral or limited study.
Table 1 offers a precise view of the difference between the codes.
Study Comparison
Noninvasive physiologic studies are nonimaging studies, and duplex studies are imaging studies. Table 2 can help coders differentiate between the two exams.
Noninvasive physiologic studies are usually done initially and, if abnormal or inconclusive results are obtained, a duplex study may be warranted. Check your local coverage determinations to see what diagnoses support medical necessity for the duplex scan procedure. If your patient doesn’t have a supporting diagnosis, obtain an advance beneficiary notice.
Some consultants believe that if a duplex study such as 93925 is done and ankle/brachial indices are measured, it is appropriate to bill both 93925 and 93922 or 93923. This is justified because the equipment for noninvasive physiologic studies is different than what is required for a duplex study.
— Laureen Jandroep, OTR, CPC-EMS, CPC-H, RCC, is a natural language processing coding analyst for CodeRyte, Inc.
Robert Ross
24. May, 2010
do you have to be a registered tech to perform and get paid for ABI?
According to the WPS LCD yes you must be a registered technologist (RVT / RVS), work under the general supervision of physicians who have demonstrated minimum entry level competency by being credentialed in vascular technology or work in an accredited lab under direct supervision of a registered tech.
LCD for Noninvasive Vascular Testing (N.I.V.T.) (L28586)
Contractor Name
Wisconsin Physicians Service Insurance Corporation
Contractor Number
00951
Revision Ending Date
04/30/2010
Utilization Guidelines
A. Training and Certification
1. The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill, and experience of the technologist and interpreter. Consequently, the physician performing and/or interpreting the study must be
capable of demonstrating documented training and experience and maintain any applicable documentation. A
vascular diagnostic study may be personally performed by a physician or a technologist.
The GAO Report to Congressional Committees entitled Medicare Ultrasound Procedures.
Consideration of Payment Reforms and Technician Qualifications Requirements states that
“Findings from several peer-reviewed studies, the Medicare Payment Advisory Commission,
and ultrasound-related professional organizations support requiring that sonographers either
have credentials or operate in facilities that are accredited, where specific quality standards
apply. In some localities and practice settings, CMS or its contractors have required that
sonographers either be credentialed or work in an accredited facility.” (GAO-07-734)
2. All non-invasive vascular diagnostic studies must be performed under at least one of the
following settings:
a. performed by a physician who is competent in diagnostic vascular
studies or under the general supervision of physicians who have demonstrated minimum
entry level competency by being credentialed in vascular technology, or
b. performed by a technician who is certified in vascular technology, or
c. performed in facilities with laboratories accredited in vascular technology.
3. One or more technologists in each vascular laboratory must be certified by a credentialing board recognized
by the Intersocietal Commission for Accreditation of Vascular Laboratories (ICAVL) or the National Council
for Certifying Agencies (NCCA) or the International Standards Organization (ISO) 17024).