Vascular Systems Resources

Peripheral Artery Disease (PAD) is a circulatory condition in which narrowed arteries reduce blood flow to the limbs, most commonly the legs. PAD is associated with significantly elevated risk of heart attack, stroke, and lower limb amputation. Routine ABI screening enables early detection before symptoms become severe or limb-threatening.

An ABI test is a non-invasive diagnostic procedure that compares blood pressure at the ankle to blood pressure at the arm. An ABI ratio below 0.9 is a clinical indicator of Peripheral Artery Disease. ABI testing is a reimbursable procedure and the first-line screening tool recommended by the American Heart Association (AHA) and Society for Vascular Surgery (SVS).

An ABI below 0.9 is considered diagnostic for PAD, with lower values reflecting more severe arterial obstruction. Values of 0.91–1.3 are normal. An ABI above 1.4 suggests arterial calcification or stiffness, which may require Toe Brachial Index (TBI) testing for accurate vascular assessment.

Yes. Single-level bilateral ABI testing is typically billed under CPT 93922. Multi-level segmental studies are billed under CPT 93923, and stress and exercise ABI testing under CPT 93924. Practices should confirm specific code selection with their billing team based on their testing protocols and payer contracts.

TBI testing measures blood pressure at the toe and compares it to the arm (brachial) pressure. It is used when standard ABI may be unreliable — particularly in patients with diabetes, chronic kidney disease, or advanced age — because toe arteries are less affected by calcification than ankle arteries. A TBI below 0.70 is generally considered abnormal.

PVR (Pulse Volume Recording) is a technology that measures volume changes in arterial blood flow through pneumatic cuffs, producing waveforms without requiring a Doppler probe. PVR waveforms provide qualitative information about arterial flow character — normal, mildly, moderately, or severely abnormal — and are used in both Doppler-free screening and comprehensive segmental studies.

A segmental pressure study measures blood pressure at multiple levels of the leg — typically upper thigh, lower thigh, calf, and ankle — simultaneously. By comparing pressures between adjacent levels, clinicians can localize arterial occlusions to a specific vascular segment (aorto-iliac, femoral, or tibial), which is critical for planning angioplasty, stenting, or bypass surgery.

An Exercise ABI test measures ABI before and immediately after treadmill walking. Some patients with significant arterial stenosis have a normal resting ABI; a post-exercise ABI drop of 20% or more confirms hemodynamically significant PAD. Exercise ABI testing is billed under CPT 93924 and is essential for diagnosing claudication and exercise-induced ischemia that resting exams miss.