Neurology & Pain Management Coding Alert

Question: Our neurologist performed a transcranial Doppler study (TCD) on a patient who complained of dizziness, so I used code 780.4, but the TCD was denied. What went wrong?

South Carolina Subscriber

Answer: If your neurologist documents that the patient has additional risk factors, such as stroke, you should use those signs and symptoms to support the medical necessity for a TCD (93886, Transcranial Doppler study of the intracranial arteries; complete study). Dizziness (780.4) will not be paid by many payers if it is the primary diagnosis code, because dizziness is an indicator of many less acute conditions (such as ear wax or an inner ear infection), and therefore does not indicate medical necessity for a diagnostic study such as a TCD.

Complete documentation of the presenting conditions that highlight medical necessity for the diagnostic procedure must include evidence of a condition that supports the need for the test. This means there must be positive evidence of signs, symptoms, or conditions that can be determined to be causes of potential cerebrovascular disease. Signs and symptoms of cerebrovascular disease (such as stroke) include complaints of paralysis or weakness of an arm, leg, and one side of the face; numbness or tingling with decreased sensation; changes in vision or loss of vision; and so on. In absence of additional complaints like these, 93886 is not supported for reimbursement.

Take note: Many payers will cover syncope (780.2) which may be a "better" code to explain the patient's signs and symptoms than "dizziness." Syncope is a partial or complete loss of consciousness and posture. Here is where good documentation comes in; when the TCD is normal, physicians won't have the "stroke" diagnosis code to report, but the diagnostic study may be covered if the patient's signs and symptoms were more accurately documented.

-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.