93922: There Are Special Rules for Unilateral Exams

Puzzled by the 2011 guidelines for 93922-93923? Not sure when to report 93922-52?


Don't be. Read on and know how you should go about it: You should report 93922-52 (Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries … 1-2 levels; Reduced services) when the patient has only one limb accessible for study and the doctor records only one or two levels.


Here's an example: A patient's right leg was amputated. The physician carries out the study on two levels on the patient's left leg. You should use 93922-52 to report unilateral, limited service.


The origin of the confusion may be that CPT guidelines for 93922 and for 93923 (Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, three or more levels … ) guide you to report limited code 93922 when the physician carries out a unilateral exam for three or more levels or using provocative functional maneuvers, on a patient with just one arm or leg available for study.


To put it in other words, this means that 93922 (without modifier 52) is proper for

A bilateral exam on one or two levels

A unilateral exam on three or more levels (i.e, lower and/or upper extremity amputee)

A unilateral exam when performing provocative functional maneuvers


Experts provide the following list to help you count levels:


Lower extremity levels


1. High thigh 2. Low thigh


3. Calf 4. Ankle


5. Metatarsal 6. Toes


Upper Extremity Levels


1. Arm 2. Forearm


3. Wrist 4. Digits


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