Noninvasive Vascular Diagnostic Studies

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. The Ankle-Brachial Index (ABI) is reportable with 93922 or 93923 as long as simultaneous Doppler recording analysis of bidirectional blood flow, volume plethysmography, or transcutaneous oxygen tension measurements are also performed.

Noninvasive physiologic studies are performed using equipment separate and distinct from the duplex ultrasound imager. Codes 93922, 93923, and 93924 describe the evaluation of non-imaging physiologic recordings of pressures with Doppler analysis of bidirectional blood flow, plethysmography, and/or oxygen tension measurements appropriate for the anatomic area studies.

Limited studies for lower extremity require either:

(1) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional Doppler waveform recording and analysis at 1-2 levels; or Doppler waveform recording and analysis at 1-2 levels; or (2) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels; or (3) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 1-2 levels. Potential levels include high thigh, low thigh, calf, ankle, metatarsal and toes.

Limited studies for upper extremity require either:

(1) Doppler-determined systolic pressures and bidirectional Doppler waveform recording and analysis at 1-2 levels; or (2) Doppler-determined systolic pressures and volume plethysmography at 1-2 levels; Potential levels include arm, forearm, wrist, and digits.

Complete studies for lower extremity require either:

(1) ankle-brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional Doppler waveform recording and analysis at 3 or more levels; or (2) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 3 or more levels; or (3) ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with transcutaneous oxygen tension measurements at 3 or more levels. Alternatively, a complete study may be reported with measurements at a single level if provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia) are performed.

Complete studies for upper extremity require either:

(1) Doppler-determined systolic pressures and bidirectional Doppler waveform recording and analysis at 3 or more levels; or (2) Doppler-determined systolic pressures and volume plethysmography at 3 or more levels; or (3) Doppler-determined systolic pressures and transcutaneous oxygen tension measurements at 3 or more levels. Potential levels include arm, forearm, wrist, and digits. alternatively, a complete study may be reported with measurements at a single-level if provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with cold stress) are performed.

CPT information obtained from
Ahlman, J, Attale, T,, et al; Standard Edition CPT Current Procedural Terminology. Am Med Assoc 2018