Neurology & Pain Management Coding Alert

Question: Our neurologist is about to start providing embolus detection services. What’s involved with this?

Ohio Subscriber

Answer: Embolus detection code 93892 (Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection) requires specialized equipment (hardware and software) and training by the physician to detect embolic events.

Note: Code 93892 is similar to many other diagnostic studies in that there are separate professional and technical components. If the neurologist is performing both in the office place of service, bill the code without any modifiers.  The procedure includes the diagnostic study of all intracranial arteries and should not be reported as bilateral if the neurologist studies both the right and left intracranial arteries. You also should not report 93892 with modifier 50 (Bilateral procedure). 

What happens: The physician applies a small amount of water-soluble gel to the skin over the area to be examined, generally the base of the skull and the area over the ears. The physician holds a transducer in place on the skin’s surface to record blood flow information. In 93892, the physician checks for emboli signals in the Doppler waveform, without the use of a microbubble injection.

Purpose: Transcranial Doppler (TCD) is a noninvasive diagnostic ultrasound evaluation of the intracranial arteries. Neurologists and other physicians may order the test to determine whether there is an artery occlusion or stenosis that could result in cerebrovascular diseases such as stroke and brain hemorrhages. This test is used to search for emboli, intravascular masses capable of clogging arterial capillary beds.