93922

Limited Bilateral Noninvasive Physiologic Studies of Extremity Arteries

CPT 93922 describes a limited bilateral noninvasive physiologic study of the arterial system in either the upper or lower extremities. This diagnostic test is fundamental in the evaluation of peripheral arterial disease (PAD), a condition characterized by narrowed arteries that reduce blood flow to the limbs. The "limited" designation signifies that the study is conducted at a single level of the extremity, most commonly the ankle for lower extremities or the wrist for upper extremities, rather than multiple levels which would be categorized as segmental pressures. The primary objective of 93922 is to obtain the Ankle-Brachial Index (ABI) or its upper-extremity equivalent. This involves measuring the systolic blood pressure at the brachial artery and the distal arteries (posterior tibial or dorsalis pedis) using specialized equipment such as a Doppler ultrasound probe and blood pressure cuffs. In addition to pressure measurements, the procedure includes qualitative assessments like Doppler waveform analysis or volume plethysmography (PVR). These modalities provide visual representations of the blood flow patterns; for instance, a normal arterial waveform is triphasic, whereas diseased vessels may exhibit monophasic or dampened patterns. The test is noninvasive, requiring no needles or contrast agents, making it an excellent first-line screening tool for patients presenting with symptoms of intermittent claudication, cold extremities, or non-healing skin ulcers. The physician or technician interprets the numerical indices and the waveform morphology to determine the severity of arterial compromise and provides a written report detailing the findings. This study is also vital for the longitudinal monitoring of patients who have undergone vascular surgical procedures, such as bypass grafting or endovascular interventions like stenting or angioplasty, to ensure long-term vessel patency and to identify early signs of graft failure or re-stenosis.

Clinical Indications

  • Intermittent claudication (pain while walking)
  • Rest pain in the extremities suggesting critical limb ischemia
  • Non-healing ulcers or gangrene on the feet or toes
  • Diminished or absent peripheral pulses on physical examination
  • Monitoring of known peripheral arterial disease (PAD)
  • Post-operative follow-up for arterial bypass grafts or stents
  • Evaluation of suspected arterial trauma or embolism
  • Assessment of extremity blood flow in patients with severe diabetes
  • Pre-operative clearance for major orthopedic or vascular surgery

Procedure Steps

  1. Patient is placed in a supine position and allowed to rest to ensure stable hemodynamics.
  2. Blood pressure cuffs are placed bilaterally on the upper arms (brachial) and at the ankles.
  3. The clinician uses a handheld Doppler probe to locate the brachial artery pulse and inflates the cuff to measure systolic pressure.
  4. The clinician moves to the lower extremities to locate the posterior tibial and dorsalis pedis pulses using the Doppler probe.
  5. Systolic pressures are recorded at the ankle level bilaterally.
  6. The Ankle-Brachial Index (ABI) is calculated by dividing the higher of the two ankle pressures by the higher of the two brachial pressures for each side.
  7. Doppler waveform analysis is performed at the level of the ankle to assess the quality of the blood flow (triphasic vs. biphasic vs. monophasic).
  8. Volume plethysmography (PVR) may be performed to record changes in limb volume with each cardiac cycle.
  9. Findings are documented, interpreted by a qualified physician, and a formal report is generated.

Coding Guidelines

  • 93922 is a bilateral procedure; if performed unilaterally, modifier -52 (Reduced Services) must be appended.
  • Do not report 93922 in conjunction with 93923 or 93924 for the same extremity during the same session.
  • The study must include at least two of the following: pressure measurements (e.g., ABI), Doppler waveform analysis, or volume plethysmography.
  • This code includes both the technical component (performance of the test) and the professional component (interpretation and report).
  • For studies involving only a handheld Doppler device without a hard copy output or formal report, use the appropriate Evaluation and Management (E/M) code instead.
  • Documentation must demonstrate medical necessity and include a comparison of findings between the left and right sides.

Associated ICD-10 Codes