Neurology & Pain Management Coding Alert

Transcranial dopplers produce a sonographic scan of carotid arteries and can be used to predict strokes and diagnose other problems related to artery stenosis. More neurologists are performing the procedures in their offices, thanks to the affordability and easy use of newer machines. But how should these in-office tests be coded?

The most important thing for neurologists to remember regarding transcranial doppler reimbursement is that you have to code for the symptom and the disease, says Brenda Orinski, RDMS, an ARRP and CRT certified radiological technologist in charge of billing for the Cerebral Blood Flow Lab at the University of California at Los Angeles. The basic code for standard transcranial doppler is 93886 (transcranial doppler study of the intracranial arteries; complete study), but keep in mind neurologists need to match it with an ICD-9 diagnosis code.

For example, if a patient has an aneurysm (441.1-442.9), you code for that. If a patient has a cerebrovascular hemorrhage, you code for stroke (436).

At Pacific Vascular in Seattle, WA, billing supervisor Diane Weymer confirms that being as specific as possible with ICD9 Codes is key for getting reimbursed for transcranial doppler scans. We often use the range of 433-436 codes, she says. These diagnosis codes include occlusion and stenosis of precerebral arteries (433), occlusion of cerebral arteries (434), transient cerebral ischemia (435), and acute, but ill-defined, cerebrovascular disease (436).

Most transcranial doppler scans take 30 to 40 minutes to complete but occasionally may take longer. Medicare and insurance companies pay a flat rate, however, regardless of the time involved. For example, an emboli study can take an extra 30 minutes of the neurologists time.

In addition, states may have different requirements for doppler operators. Medicare carriers in a few states, such as Virginia, require a registered vascular technologist to perform the procedure. Certification is provided by the Society of Vascular Technology (SVT). More states are expected to add this requirement, but most carriers now will accept a doppler scan performed by any health professional operating under the on-site supervision of a physician. But most carriers will ask that labs performing transcranial doppler scans be accredited by SVT.