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A transcranial Doppler study is a non-invasive ultrasound procedure used to assess blood flow in the intracranial arteries, specifically for the purpose of detecting emboli. In this context, emboli refer to small particles or clots that can travel through the bloodstream and potentially cause blockages in the cerebral arteries. The study is conducted without the use of intravenous microbubble injection, which is a contrast agent typically used in other imaging studies to enhance visualization. Instead, the detection of emboli relies on the identification of short-duration, high-intensity signals that are generated by the Doppler ultrasound as it measures the movement of blood cells and any embolic material present in the blood flow. The intensity of these signals varies based on the density of the embolus compared to the surrounding blood cells, with gaseous emboli producing the highest intensity signals, while solid emboli, such as those formed from thrombotic, platelet, or atheromatous material, yield slightly lower intensity signals. During the procedure, a gel is applied to the patient's skin to facilitate the transmission of ultrasound waves. A handheld Doppler probe is then positioned on the skin, typically over the temporal bone, and directed at the middle cerebral arteries (MCA) on both sides of the head. Continuous monitoring of blood flow in the MCAs is performed, and the data is recorded on a specialized computer system that provides both auditory and visual feedback. A computer algorithm analyzes the recorded data to assist in identifying any high-intensity embolic signals, which the physician subsequently reviews to distinguish between genuine embolic signals and artifacts. Finally, the physician compiles a written report summarizing the findings of the study, which is essential for further clinical decision-making.
© Copyright 2025 Coding Ahead. All rights reserved.
The transcranial Doppler study of the intracranial arteries is indicated for the detection of emboli in patients who may be at risk for cerebrovascular events. The following conditions and symptoms may warrant this procedure:
The transcranial Doppler study involves several key procedural steps to ensure accurate detection of emboli:
Post-procedure care for patients undergoing a transcranial Doppler study is generally minimal due to the non-invasive nature of the test. Patients can typically resume their normal activities immediately following the procedure. However, the physician may provide specific instructions based on the individual patient's condition and the findings of the study. It is important for the physician to discuss the results with the patient, including any detected embolic signals and potential implications for further evaluation or treatment. Follow-up appointments may be scheduled to monitor the patient's condition and address any ongoing concerns related to cerebrovascular health.
| Short Descr | TCD EMBOLI DETECT W/O INJ | Medium Descr | TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT | Long Descr | Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services apply... | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Type of Service (TOS) | 6 - Therapeutic Radiology | Berenson-Eggers TOS (BETOS) | I4B - Imaging/procedure - other | MUE | 1 | CCS Clinical Classification | 192 - Diagnostic ultrasound of head and neck |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | GW | Service not related to the hospice patient's terminal condition | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GZ | Item or service expected to be denied as not reasonable and necessary | N2 | Group 2 oxygen coverage criteria met | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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