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What is a physiological arterial evaluation?
Ankle/Brachial Index: ABI
A blood pressure cuff is placed on th arm and the ankles bilaterally. The systolic pressures are compared to the blood pressure at your arms and ankles, with a low ABI indicating PAD.
Pulsed Volume Recording: PVR
Cuffs are placed on the arms and at 3 or 4 sections of both legs. The cuffs are inflated slightly and the total volume change within the leg or arm is measured.
Cuffs are placed on the arms and legs. The blood pressure is taken at each cuff and compared to the pressure in the arm. This is a useful tool in the localization of arterial disease or stenosis.
Toe/Brachial Index: TBI
A small digit cuff and PPG sensor are placed on the great toe. The pressure and waveform are compared to the brachial pressure. Pressure less than 0.65 indicates decreased flow to small vessels of the toe.
Common ICD-9-CM Codes for PAD
250.70-250.73 – Diabetes with peripheral circulatory disorders
440.21 – Atherosclerosis of native arteries of the extremities with intermittent claudication
440.22 – Atherosclerosis of native arteries with rest pain
440.23 – Atherosclerosis of native arteries with ulcerations
440.3-440.32 – Atherosclerosis of bypass graft of the extremities
443.0-443.1 – Raynaud’s syndrome/thromboagngitis obliteranms
443.89 – Other peripheral vascular disease
443.9 – Peripheral vascular diseas unspecified
707.10 – Unspecified ulcer of lower limb
707.11 – Ulcer of thigh
707.12 – Ulcer of calf
707.13 – Ulcer of ankle
707.14 – Ulcer of midfoot
707.15 – Ulcer of foot
707.19 – Ulcer of lower limb
707.8 – Chronic ulcer of other specified sites
785.4 – Gangrene
ICD-9 codes are subject to verification. Please refer to the LMRP guidelines for the Medicare provider in your area. Information obtained through the US Department of Health and Human Services for Medicare and Medicaid services (http://www.cms.hhs.gov/)
Symptoms of PAD
- Pain or cramping in feet, calves or thighs after activity
- Leg numbness or weakness
- Coldness in toes or feet when compared to the other side
- Non-healing wounds of ulcers on ties, feet or calves
- Cyanosis of the toes or feet
- Hair loss on feet and legs
- Shiny of scaly appearance to the skin on feet and legs
- Slow nail growth
- Decreased or absent pulses in feet
Risk Factors for PAD
- Current of previous smoker
- High blood pressure
- High cholesterol
- Family history of heart disease or stroke
- Patients 50 and older
How to Order a Non-Invasive Arterial Study
93922 – Unilateral or limited study use when only an ABI is needed or the study is in any way limited
93923 – Bilateral/Complete study includes ABI, PVR, segmental pressures and bi-directional waveform analysis
TBI will be done when written on the order. There is no additional charge for TBI.