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Neurology & Pain Management Coding Alert

READER QUESTIONS:

TCD Needs Additional Risk Factors for Payment

Published on Fri Sep 18, 2009

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 [...]
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