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Ultrasound Code 93922 and 93923


Question

We are getting an error when we bill CPT 93922 Brachial Bilateral 93923 Arterial. Can these be billed with a modifier or is the 93922 included 93923?

Answer

These two codes should not be billed together.  93922 is for a single level.  93923 is for multiple levels. The codes are for lower or upper extremity arteries.  If you are doing one study on lower extremities and another on upper extremities, you could use both codes with modifier 59. Here is information from CPT Assistant, August 2009:  Code 93922 represents a noninvasive physiologic arterial study of either both upper extremities (UE) or both lower extremities (LE) performed at only one level of the involved extremities. An example of a single level study is an evaluation of non-imaging physiologic recordings of pressures, Doppler analysis of bi-directional blood flow, plethysmography, and/or oxygen tension measurements at each ankle. Again, if this evaluation does not produce hard copy output or, for Doppler testing produces a record that does not permit analysis of bi-directional blood flow direction, then the evaluation is considered to be part of the part of the E/M service and is not separately reportable.
 
CPT code 93923 represents a noninvasive physiologic arterial study of both UE or both LE performed at multiple levels of the involved extremities. An example of a multiple level study is the evaluation of multiple levels of non-imaging physiologic recordings of pressures, Doppler analysis of bi-directional blood flow, plethysmography, and/or oxygen tension measurements of the two LE’s or two UE’s. Code 93923 describes "noninvasive physiologic studies of upper or lower extremity arteries,"1 which indicates that if both the UE and the LE arteries are studied in this fashion, then code 93923 should be reported twice, once for the UE and once for the LE. In this instance, modifier 59, Distinct procedural service, should be appended to the second listing of code 93923 on the claim form.  
 
When only performing studies to the UE or LE, it is inappropriate to code 93922 in conjunction with 93923 because code 93923 includes segmental pressures and tracings, and is used to report more complex bilateral noninvasive physiologic testing procedures. 

Disclaimer: All articles intended for general guidance only and not as a recommendation for a specific situation. Readers should consult an official source (AHA, AMA, etc.) or a qualified attorney for specific legal guidance.
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