93925

Non-invasive physiologic studies of extremity arteries, duplex scan and segmental blood pressure with plethysmography and/or Doppler wave analysis, one extremity

CPT code 93925 describes a comprehensive non-invasive diagnostic study of the arterial system of a single upper or lower extremity. This procedure combines three distinct modalities to assess arterial blood flow, identify vascular pathology, and determine the severity and location of arterial disease. The study typically involves: 1) a duplex ultrasound scan, which utilizes real-time B-mode imaging to visualize arterial anatomy and color/pulsed Doppler to evaluate blood flow characteristics and identify areas of stenosis or occlusion; 2) segmental blood pressure measurements, taken at multiple levels along the extremity (e.g., high thigh, above-knee, below-knee, ankle for lower extremities, or upper arm, forearm, wrist for upper extremities) and compared to brachial pressures to detect pressure gradients; and 3) either plethysmography (volume or pulse recordings) or Doppler waveform analysis, performed at various arterial sites to provide additional information on arterial patency and flow dynamics. The combination of these techniques allows for a detailed assessment of peripheral artery disease (PAD), occlusive disease, aneurysms, and other arterial abnormalities, aiding in diagnosis, treatment planning, and monitoring.

Clinical Indications

  • Evaluation of symptoms suggestive of peripheral artery disease (PAD), such as intermittent claudication (pain, cramping, aching in legs during exercise, relieved by rest).
  • Assessment of ischemic rest pain in an extremity.
  • Investigation of non-healing wounds, ulcers, or gangrene on an extremity.
  • Presence of diminished or absent peripheral pulses.
  • Abnormal ankle-brachial index (ABI) or toe-brachial index (TBI) from a prior screening.
  • Pre-operative assessment for vascular interventions or surgical procedures (e.g., bypass grafting, amputation planning).
  • Post-operative evaluation of vascular graft or stent patency and function.
  • Follow-up and monitoring of known peripheral artery disease progression or response to treatment.
  • Evaluation of suspected arterial stenosis, occlusion, or aneurysm.
  • Assessment of arterial trauma, pseudoaneurysm, or arteriovenous fistula.

Procedure Steps

  1. Patient is positioned supine, and allowed to rest to stabilize hemodynamics.
  2. Blood pressure cuffs are applied at multiple levels along the affected extremity (e.g., high thigh, above-knee, below-knee, ankle for lower extremities; upper arm, forearm, wrist for upper extremities) and on the brachial artery.
  3. Segmental blood pressures are measured at each cuff level, typically using a continuous-wave Doppler probe to detect arterial flow distal to the cuff.
  4. Ankle-Brachial Index (ABI) or Toe-Brachial Index (TBI) is calculated by dividing ankle or toe systolic pressures by the higher of the two brachial systolic pressures.
  5. Doppler waveform analysis or plethysmographic sensors are placed at various arterial sites to record pulse volumes or spectral waveforms, assessing flow characteristics.
  6. A duplex ultrasound scan is performed to visualize the major arteries of the extremity (e.g., common femoral, superficial femoral, popliteal, tibial arteries for lower extremities; subclavian, axillary, brachial, radial, ulnar arteries for upper extremities).
  7. B-mode imaging is used to assess vessel wall morphology, lumen patency, and presence of plaque or thrombus.
  8. Color Doppler and pulsed-wave Doppler are used to evaluate blood flow direction, velocity, and spectral characteristics, identifying areas of stenosis, occlusion, or aneurysm formation.
  9. All findings, including images, waveforms, pressure measurements, and calculated indices, are documented comprehensively.
  10. A detailed report interpreting the findings and their clinical significance is generated by the physician.

Coding Guidelines

  • CPT 93925 represents a complete study for one extremity. If both extremities are studied, it should typically be reported twice (e.g., 93925 x 2) or with modifier -50 for bilateral if accepted by the payer, or modifier -59 on the second unit to indicate a distinct procedural service.
  • This code includes the performance of a duplex scan, segmental blood pressure measurements, and either plethysmography or Doppler waveform analysis. These components should not be billed separately when performed as part of 93925.
  • Only use CPT 93925 when all three required modalities (duplex scan, segmental blood pressures, AND plethysmography/Doppler wave analysis) are performed for a single extremity.
  • If only a duplex scan of extremity arteries is performed without segmental pressures and plethysmography/Doppler wave analysis, refer to CPT 93926.
  • If only physiologic studies (segmental pressures, plethysmography/Doppler wave analysis) are performed without a duplex scan, refer to CPT 93923 for complete bilateral or 93922 for limited bilateral studies, or if for a single extremity, consider unlisted codes or specific component codes if appropriate and not bundled.
  • Documentation must clearly delineate all components performed: duplex imaging findings, segmental pressure values with calculated indices, and plethysmography/Doppler waveform analysis for the specified extremity.
  • Modifier -59 (Distinct Procedural Service) may be required on the second unit of 93925 when reporting bilateral studies to indicate that the service was performed on the contralateral extremity and is a separate and distinct procedure.

Associated ICD-10 Codes