LCD/NCD Portal

L29293

 

TRANSCRANIAL DOPPLER STUDIES

 

10/01/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

 

Medicare considers transcranial Doppler evaluation of the intracranial cerebrovascular system to be considered medically necessary in any of the following circumstances (see the “ICD-9 Codes That Support Medical Necessity” section of this policy):

• The patient has suspected severe intracranial arterial stenosis based on finite clinical evidence of focal ischemia, and knowledge of this stenosis is necessary in order to properly care for the patient.

• The patient has areas of known severe stenosis or occlusion of arteries supplying the brain and assessment of the pattern and extent of collateral circulation is necessary in order to properly care for the patient.

• The patient has suffered a subarachnoid hemorrhage and transcranial Doppler studies are necessary to assess vasoconstriction of cerebral vessels.

• The patient has suspected or confirmed arteriovenous malformation, and an assessment of the arterial supply and flow pattern is necessary.

• The patient has suspected brain death.

• Headaches or dizziness are NOT indications for transcranial Doppler studies of the intracranial vessels unless associated with other localizing signs and symptoms such as nystagmus, limb ataxia, etc.

• Transcranial Doppler studies performed to monitor cerebral vascular resistance and the effects of vasodilators and other drugs in the treatment of stroke and other brain damage is considered investigational, and therefore NOT covered by Medicare.

• The use of a simple hand-held or other Doppler device that does not produce hard copy output, or that produces a record that does not permit analysis of bidirectional vascular flow, is considered part of the physical examination of the vascular system and is NOT separately reported (CPT 2004, page 355).

o The appropriate assignment of a specific ultrasound CPT code is NOT solely determined by the weight, size, or portability of the equipment, but rather by the extent, quality, and documentation of the procedure.

o If an examination is performed with hand-carried equipment, the quality of the exam, printout, and report must be in keeping with accepted national standards.

 

CPT/HCPCS Codes

 

93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY

93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY

93890 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; VASOREACTIVITY STUDY

93892 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITHOUT INTRAVENOUS MICROBUBBLE INJECTION

93893 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; EMBOLI DETECTION WITH INTRAVENOUS MICROBUBBLE INJECTION

 

 

ICD-9 Codes that Support Medical Necessity

 

348.81 TEMPORAL SCLEROSIS

348.89 OTHER CONDITIONS OF BRAIN

430 SUBARACHNOID HEMORRHAGE

433.00 OCCLUSION AND STENOSIS OF BASILAR ARTERY WITHOUT CEREBRAL INFARCTION

433.01 OCCLUSION AND STENOSIS OF BASILAR ARTERY WITH CEREBRAL INFARCTION

433.10 OCCLUSION AND STENOSIS OF CAROTID ARTERY WITHOUT CEREBRAL INFARCTION

433.11 OCCLUSION AND STENOSIS OF CAROTID ARTERY WITH CEREBRAL INFARCTION

433.20 OCCLUSION AND STENOSIS OF VERTEBRAL ARTERY WITHOUT CEREBRAL INFARCTION

433.21 OCCLUSION AND STENOSIS OF VERTEBRAL ARTERY WITH CEREBRAL INFARCTION

433.30 OCCLUSION AND STENOSIS OF MULTIPLE AND BILATERAL PRECEREBRAL ARTERIES WITHOUT CEREBRAL INFARCTION

433.31 OCCLUSION AND STENOSIS OF MULTIPLE AND BILATERAL PRECEREBRAL ARTERIES WITH CEREBRAL INFARCTION

434.00 CEREBRAL THROMBOSIS WITHOUT CEREBRAL INFARCTION

434.01 CEREBRAL THROMBOSIS WITH CEREBRAL INFARCTION

434.10 CEREBRAL EMBOLISM WITHOUT CEREBRAL INFARCTION

434.11 CEREBRAL EMBOLISM WITH CEREBRAL INFARCTION

434.90 CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITHOUT CEREBRAL INFARCTION

434.91 CEREBRAL ARTERY OCCLUSION UNSPECIFIED WITH CEREBRAL INFARCTION

435.0 BASILAR ARTERY SYNDROME

435.1 VERTEBRAL ARTERY SYNDROME

747.81 CONGENITAL ANOMALIES OF CEREBROVASCULAR SYSTEM

 

 

Documentation Requirements

• Medical record documentation maintained by the ordering/referring physician/nonphysician practitioner must clearly indicate the medical necessity of transcranial Doppler studies covered by the Medicare program.

o Also, the results of transcranial Doppler studies covered by the Medicare program must be included in the patient's medical record.

o This information is normally found in the office/progress notes, hospital notes, and/or test results.

• If the provider of transcranial Doppler studies is other than the ordering/referring physician/nonphysician practitioner, the provider of the service must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies.

o The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his/her order for the test.

Treatment Logic

• Transcranial Doppler uses low-frequency Doppler transducers applied across the thin portions of the temporal bone (the temporal acoustic windows) to obtain flow velocity information from the basal intracerebral arteries.

• The transtemporal acoustic window provides access to hemodynamic data from the middle, anterior, and posterior cerebral arteries.

• A suboccipital approach, with insonation through the foramen magnum, provides access to the intracranial vertebral and basilar arteries, while a transorbital approach can be used to insonate the ophthalmic artery and the carotid siphon via the optic foramen.

• This data allows evaluation of the direction, depth, speed, and characteristics of flow in these vessels.

 

Sources of Information and Basis for Decision

 

Society of Vascular Ultrasound-Professional performance guidelines. (2003). Transcranial Doppler (Non-Imaging). Retrieved September 13, 2005, from http://www.svunet.org/about/positions.

 

Sloan, M.A., Alexandrov, A.V., Tegeler, C.H., Spencer, M.P., Caplan, L.R., Feldman, E., et al. (2004). Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of The American Academy of Neurology. Retrieved September 13, 2005, from http://www.neurology.org/cgi/content/full/62/9/1468.

 

10/01/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD TRANSCRANIAL DOPPLER STUDIES