Ankle Brachial 2021 Coding and Index Reimbursement Guide - CooperSurgical
[Pages:5]Ankle Brachial Index
2021 Coding and Reimbursement Guide
Reimbursement and coding information provided herein is gathered from third-party sources and is subject to change. This information is presented for illustrative purposes only. This information does not constitute reimbursement or legal advice, and is not intended as a guarantee of coverage or payment at any particular payment rate. CooperSurgical makes no representation or warranty regarding this information or its completeness, accuracy or timeliness. Laws, regulations and payer policies concerning reimbursement are complex and change frequently. The decision about which code(s) to report must be made by the billing provider/ physician considering the clinical facts, circumstances, and applicable coding rules. The code(s) selected should be supported by the contents of any clinical notes and/or chart documentation. Please contact your third-party payer for more specific guidance.
CPT? Code: 93922 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries.
CPT? Code: 93923 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels.
CPT? Code: 93924 Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing.
Possible ICD-10-CM Diagnosis Codes for Procedure Code 93922, 93923 and 93924
Not all inclusive diagnosis code list. Refer to 2021 ICD-10-CM manual for code specificity. Note: Arterial exams must be considered "medically necessary" in order to be eligible for reimbursement.
E08-E13 - Diabetes Mellitus
For specificity, refer to additional codes within this category.
ICD-10-CM DIAGNOSIS CODES
E09.59
Drug or chemical induced diabetes mellitus with other circulatory complications
E10.59
Type 1 diabetes mellitus with other circulatory complications
E11.59
Type 2 diabetes mellitus with other circulatory complications
E13.59
Other specified diabetes mellitus with other circulatory complications
Not all inclusive diagnosis code list. Refer to manual for code specificity.
I70-I79 - Diseases of arteries, arterioles and capillaries
For extended ICD-10 diagnosis specific to extremity and anatomical location refer to: I70.231 ? I70.249
ICD-10-CM DIAGNOSIS CODES
I70.219 Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
I70.228 Atherosclerosis of native arteries of extremities with rest pain, other extremity
I70.229 Atherosclerosis of native arteries of extremities with rest pain, unspecified extremity
I70.25
Atherosclerosis of native arteries of other extremities with ulceration
I70.269 Atherosclerosis of native arteries of extremities with gangrene, unspecified extremity
I70.299 Other atherosclerosis of native arteries of extremities, unspecified extremity
Aneurysm
ICD-10-CM DIAGNOSIS CODES
I72.4
Aneurysm of artery of lower extremity
Peripheral Vascular Disease
ICD-10-CM DIAGNOSIS CODES
I73.9
Peripheral vascular disease, unspecified
The above codes are examples only. Check the appropriate Medicare Administrative Contractor (MAC) local coverage policy for your jurisdiction for a complete list of ICD-10-CM codes.
Ankle Brachial Index
2021 Coding and Reimbursement Guide
2021 Medicare Part B Fee Schedule
MEDICARE GLOBAL IN-OFFICE (NON-FACILITY) REIMBURSEMENT
LOCATION
Alabama Alaska Arizona Arkansas California-Anaheim/Santa Ana (26) California-Los Angeles (18) California-Napa (51) California-Marin (52) California-Solano (53) California-Butte County (55), Fresno County (56), Kings County (57), Madera County (58), Merced County (59), Stanislaus County (60), Shasta County (61), San Joaquin County (68), Tulare County (69), Sutter County (70), all other Counties (75) California-Kern County (54) California-San Luis Obispo County (73) California-Riverside and San Bernardino County (62) California-Placer and Sacramento County (63) California-Monterey County (64) California-Santa Cruz County (66) California-Sonoma County (67) California-Oakland/Berkeley (07) California-San Benito County (65) California-San Francisco (05) California-San Mateo (06) California-San Diego (72) California-Santa Clara (09) California-Ventura (17) California-Santa Barbara County (74) California-Imperial County (71) Colorado
CPT Code 93922 $78.50 $99.98 $83.22 $74.55 $100.66 $100.66 $103.64 $110.86 $103.64
CPT Code 93923 $121.75 $155.74 $128.96 $115.85 $155.65 $155.65 $160.23 $171.29 $160.23
$91.75
$142.07
$92.01 $93.29 $92.28 $92.91 $96.40 $100.79 $99.10 $112.21 $112.59 $112.21 $112.21 $98.00 $116.45 $100.73 $98.91 $91.79 $90.44
$142.46 $144.41 $142.80 $143.85 $149.22 $155.87 $153.30 $173.38 $173.95 $173.38 $173.38 $151.60 $179.88 $155.71 $153.00 $142.12 $139.98
CPT Code 93924 $150.76 $192.68 $159.91 $143.60 $193.56 $193.56 $199.51 $213.42 $199.51
$176.57
$176.97 $179.52 $177.30 $178.79 $185.52 $193.95 $190.70 $216.07 $216.68 $216.07 $216.07 $188.56 $224.26 $193.71 $190.34 $176.61 $173.87
Ankle Brachial Index
2021 Coding and Reimbursement Guide
2021 Medicare Part B Fee Schedule
LOCATION
Connecticut Delaware Florida-Ft. Lauderdale (03) Florida-Miami (04) Florida-Rest of Florida (99) (formerly 01/02) Georgia-Atlanta (01) Georgia-Rest of Georgia (99) Hawaii/Guam Idaho Illinois-Suburban Chicago (15) Illinois-Chicago (16) Illinois-East St. Louis (12) Illinois-Rest of Illinois (99) Indiana Iowa Kansas Kentucky Louisiana-New Orleans (01) Louisiana-Rest of Louisiana (99) Maine-Southern Maine (03) Maine-Rest of Maine (99) Maryland-Baltimore/Surrounding Co. (01) Maryland-Rest of Maryland (99) Massachusetts-Metropolitan Boston (01) Massachusetts-Rest of Massachusetts (99) Michigan-Detroit (01) Michigan-Rest of Michigan Minnesota Mississippi
MEDICARE GLOBAL IN-OFFICE (NON-FACILITY) REIMBURSEMENT
CPT Code 93922 $96.19 $88.84 $88.81
$91.84 $83.31 $86.91 $77.70 $97.73 $76.77 $92.92 $92.23 $83.93 $80.79 $78.62 $79.09 $79.22 $76.87 $82.55 $77.94 $86.40 $78.80 $95.39 $90.29 $102.97 $91.87 $88.09 $80.36 $87.10 $74.53
CPT Code 93923 $148.78 $137.51 $137.25 $141.70 $128.97 $134.57 $120.54 $151.12 $119.23 $143.61 $142.48 $129.87 $125.19 $122.04 $122.76 $122.96 $119.30 $127.79 $120.82 $133.84 $122.26 $147.46 $139.70 $159.15 $142.19 $136.20 $124.58 $134.98 $115.76
CPT Code 93924 $184.80 $170.64 $169.74 $174.86 $159.55 $166.96 $149.25 $187.97 $147.91 $177.97 $176.30 $160.54 $154.94 $151.42 $152.36 $152.58 $147.73 $158.00 $149.34 $166.19 $151.58 $182.91 $173.31 $197.92 $176.56 $168.56 $154.30 $167.83 $143.36
Ankle Brachial Index
2021 Coding and Reimbursement Guide
2021 Medicare Part B Fee Schedule
LOCATION
Missouri-Metro St. Louis (01) Missouri-Metro Kansas City (02) (formerly 02/03) Missouri-Rest of Missouri (99) (formerly 01/06) Montana Nebraska Nevada New Hampshire New Jersey-Northern New Jersey (01) New Jersey-Rest of New Jersey (99) New Mexico New York-Manhattan (01) New York-NYC Suburbs/Long Island (02) New York-Poughkeepsie/N NYC Suburbs (03) New York-Queens (04) New York-Rest of New York (99) North Carolina North Dakota Ohio Oklahoma Oregon-Portland (01) Oregon-Rest of Oregon (99) Pennsylvania-Metro Philadelphia (01) Pennsylvania-Rest of Pennsylvania (99) Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas-Brazoria (09)
MEDICARE GLOBAL IN-OFFICE (NON-FACILITY) REIMBURSEMENT
CPT Code 93922 $85.20 $83.59 $75.57 $87.19 $78.84 $87.89 $90.01 $102.86 $98.31 $79.54 $105.10 $107.72 $96.66 $108.12 $83.35 $81.39 $86.24 $80.72 $77.72 $91.45 $82.35 $94.14 $82.35 $87.82 $91.07 $79.25 $86.09 $78.06 $88.49
CPT Code 93923 $131.96 $129.51 $117.32 $134.98 $122.41 $135.97 $139.28 $158.97 $152.00 $123.28 $162.16 $165.98 $149.31 $166.62 $129.17 $126.18 $133.65 $125.10 $120.59 $141.61 $127.71 $145.57 $127.63 $135.94 $140.93 $122.95 $133.44 $121.17 $137.13
CPT Code 93924 $163.67 $160.58 $145.22 $167.43 $152.04 $168.43 $172.89 $197.61 $188.84 $152.54 $200.94 $205.36 $185.03 $206.17 $160.24 $156.42 $166.10 $154.88 $149.39 $176.03 $158.53 $180.61 $158.21 $168.63 $174.89 $152.42 $165.89 $150.31 $170.34
Ankle Brachial Index
2021 Coding and Reimbursement Guide
2021 Medicare Part B Fee Schedule
LOCATION
Texas-Dallas (11) Texas-Galveston (15) Texas-Houston (18) Texas-Beaumont (20) Texas-Fort Worth (28) Texas-Austin (31) Texas-Rest of Texas (99) Utah Vermont Virgin Islands Virginia Washington-Seattle/King Co. (02) Washington-Rest of Washington (99) Washington D.C.- MD/VA Suburbs West Virginia Wisconsin Wyoming
MEDICARE GLOBAL IN-OFFICE (NON-FACILITY) REIMBURSEMENT
CPT Code 93922 $88.64 $88.72 $89.56 $82.15 $86.18 $90.96 $83.05 $80.66 $86.56 $87.82 $86.67 $102.05 $87.86 $106.33 $76.68 $81.55 $86.96
CPT Code 93923 $137.33 $137.48 $138.68 $127.39 $133.58 $140.81 $128.76 $125.08 $134.10
$135.94 $134.20 $157.73 $136.05 $164.19 $118.92 $126.54 $134.65
CPT Code 93924 $170.62 $170.78 $172.08 $158.12 $165.90 $175.07 $159.83 $155.04 $166.58
$168.63 $166.50 $196.20 $168.93 $203.98 $147.01 $157.21 $167.10
*For a complete list of ICD-10-CM diagnosis codes, please consult the 2021 ICD-10-CM codebook. CooperSurgical is not suggesting that the above CPT codes will be covered if you use these ICD codes.
For More Information
Contact the Reimbursement Center at 888.925.8166 or reimbursement@
Sources: ? 2021 AMA CPT Professional Edition ? 2021 ICD-10-CM The Complete Official Codebook, AMA ? 2021 National Physician Fee Schedule Relative Value File CY2021 Final Rule 12/28/2020 ? Medicare - National Correct Coding Policy Manual, Physician Version 23 Effective January 1, 2021 ? Reference: 2021
Current Procedural Terminology (CPT?) copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
? 2021 CooperSurgical, Inc.
C-US-ABI-000001 Rev. 2/21
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