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 diagnostic ultrasound evaluation of the intracranial arteries in the head. Neurologists use it to determine if there is an occlusion or stenosis of an artery that can result in cerebrovascular diseases (CVD) such as stroke and brain hemorrhages.

You might instead use 93888 (... limited study) if the diagnostic study only evaluated two or fewer of the circulation territories.

The remedy: Work with your provider on providing accurate documentation of signs, symptoms, and diagnoses that provide support. Having your neurologist include a letter with your appeal explaining what the test is  and what it's intended to prevent may help.