CPT® Code 93668

Official Description

Peripheral arterial disease (PAD) rehabilitation, per session

Common Language Description

Peripheral artery disease (PAD) rehabilitation is a specialized program designed to assist patients suffering from PAD, particularly those experiencing intermittent claudication or who have recently undergone peripheral vascular surgeries such as angioplasty, stenting, or grafting. This rehabilitation is crucial for improving the patient's functional capacity and overall quality of life. The program is structured under the guidance of a physician, ensuring that a non-physician healthcare provider, such as an exercise physiologist or nurse, can effectively develop and implement a tailored rehabilitation plan. The rehabilitation sessions typically involve exercise on a motorized treadmill or track, where the patient's exercise threshold is determined based on their symptoms. The supervising provider closely monitors the patient's response to the exercise, adjusting the workload as necessary to optimize safety and effectiveness. When the patient reaches their symptom-limited threshold, they are instructed to rest until their symptoms subside before resuming exercise, with the goal of accumulating a total of 30 to 45 minutes of exercise time. The physician's role is critical, as they must be readily available during these sessions to provide supervision, evaluate the rehabilitation program, train personnel, and establish safety standards. They are also prepared to intervene in case of any complications, such as angina or arrhythmia. Typically, patients participate in PAD rehabilitation three times a week for a minimum duration of 12 weeks, and the services are delivered in a group setting, with billing occurring once per patient for each session attended.

1. Indications

The indications for peripheral arterial disease (PAD) rehabilitation include the following:

Intermittent Claudication Patients experiencing pain or discomfort in the legs during physical activity due to inadequate blood flow.
Recent Peripheral Vascular Surgery Individuals who have undergone procedures such as angioplasty, stenting, or grafting to improve blood flow in the peripheral arteries.

2. Procedure

The procedure for PAD rehabilitation involves several key steps that ensure the program is effective and safe for the patient.

Step 1: Initial Assessment The rehabilitation process begins with an initial assessment conducted by a non-physician healthcare provider, such as an exercise physiologist or nurse. This assessment evaluates the patient's current physical condition, medical history, and specific symptoms related to PAD.
Step 2: Development of Rehabilitation Program Based on the initial assessment, the healthcare provider develops a personalized rehabilitation program tailored to the patient's needs. This program includes structured exercise sessions designed to improve the patient's exercise tolerance and overall cardiovascular health.
Step 3: Exercise Sessions The rehabilitation sessions typically take place on a motorized treadmill or track. During these sessions, the patient exercises under the supervision of the healthcare provider, who monitors the patient's response to the exercise and adjusts the workload as necessary to ensure safety and effectiveness.
Step 4: Monitoring and Adjustments As the patient exercises, the supervising provider closely observes their symptoms and performance. When the patient reaches their symptom-limited exercise threshold, they are instructed to rest until their symptoms diminish. After resting, the patient resumes exercise until they have accumulated a total of 30 to 45 minutes of exercise time.
Step 5: Physician Supervision Throughout the rehabilitation sessions, a supervising physician must be immediately available, although they do not need to be present in the room. The physician provides ongoing supervision of the program, ensuring that safety standards are met and that personnel are adequately trained.
Step 6: Intervention Protocol The physician is also responsible for intervening if any complications arise during the sessions, such as angina or arrhythmia, ensuring the patient's safety and well-being.

3. Post-Procedure

After completing the PAD rehabilitation sessions, patients are expected to continue their exercise regimen as advised by their healthcare provider. The typical course of rehabilitation involves attending sessions three times a week for at least 12 weeks. Patients may experience improved symptoms, increased exercise tolerance, and enhanced overall cardiovascular health as a result of the program. Follow-up assessments may be scheduled to monitor progress and make any necessary adjustments to the rehabilitation plan. It is essential for patients to adhere to the recommendations provided by their healthcare team to maximize the benefits of the rehabilitation program.

Short Descr	PERIPHERAL VASCULAR REHAB
Medium Descr	PERIPHERAL ARTERIAL DISEASE REHAB PER SESSION
Long Descr	Peripheral arterial disease (PAD) rehabilitation, per session
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	3 - Technical Component Only Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	9 - Other Medical Items or Services
Berenson-Eggers TOS (BETOS)	M5D - Specialist - other
MUE	1
CCS Clinical Classification	215 - Other physical therapy and rehabilitation

GZ	Item or service expected to be denied as not reasonable and necessary
KX	Requirements specified in the medical policy have been met
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
CC	Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)