Neurology & Pain Management Coding Alert

Question: My neurologist ordered a complete transcranial Doppler test (TCD) for a patient who was presenting with dizziness. This patient also had additional risk factors for stroke. We used 780.4 (for dizziness) as the primary diagnosis code, but our payment was denied. How was this incorrect? North Carolina Subscriber Answer: You may have received a denial because you failed to prove medical necessity by including a nonspecific or non-covered diagnosis. Crucial: The real key to TCD payment is submitting complete documentation of the presenting and even preexisting conditions that prove medical necessity for the diagnostic procedure. 780.4 may be too general, because it is an indicator of a number of less acute conditions. Many payers include coverage for TCD diagnostic studies for syncope (780.2), ataxic gait (781.2) or ataxia (781.3), or headache (784.0). You would report 93886 (Transcranial Doppler study of the intracranial arteries; complete study). TCD is a noninvasive [...]