03/11/2021

Denial for CPT 93923-Not Medically Necessary

Got denial for a vascular study 93923 for "not deemed medical necessity" for Dx: I70.293, G60.8. What ICD-10 should be used in a non-DM pt for this procedure code? Thanks

There are a large number of codes that can be billed for an ABI- the specific atherosclerosis code was denied by Medicare correctly as a non-covered diagnosis. Below is the link for the coding article for this test- there are a large number of conditions that are covered, such as:

• Diabetes with circulatory disorders
• Atherosclerosis
• Ulcers
• Gangrene
• Vascular injuries

https://www.cms.gov/medicare-coverage-database/details/article-details.aspx?articleid=56758&ver=38&keyword=&keywordType=starts&areaId=s41&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=93923&hcpcsEndCode=93923&sortBy=title&bc=AAAAAAQAAAAA