© Copyright 2025 American Medical Association. All rights reserved.
A transcranial Doppler study, specifically coded as CPT® 93893, is a specialized ultrasound examination used to assess blood flow in the intracranial arteries. This procedure is particularly focused on detecting venous-arterial shunts, which are abnormal connections between veins and arteries that can lead to significant clinical implications. The study involves the intravenous injection of agitated saline, commonly referred to as a "bubble test," which serves as a contrast agent to enhance the visualization of blood flow dynamics. The presence of a right-to-left shunt, often occurring through a patent foramen ovale, is notably associated with cryptogenic acute ischemic strokes, especially in younger patients under the age of 55. During the procedure, intravenous access is established to facilitate the injection of the agitated saline. A gel is applied to the patient's skin to ensure proper contact and transmission of ultrasound waves. A handheld Doppler probe is then strategically positioned over the temporal bone to monitor the middle cerebral arteries (MCA) bilaterally. Continuous monitoring is conducted, and the data is recorded on a computer system that provides both auditory and visual feedback. After the recording phase, the physician meticulously reviews the Doppler spectral waveforms, analyzing flow direction, velocity, and pulsatility index values. This comprehensive evaluation includes the waveforms captured before, during, and after the saline injection, allowing for the identification of any high-intensity transient embolic signals, which must be distinguished from artifacts. The physician also counts the total number of post-injection embolic signals and notes any significant patterns, such as a "shower" or "curtain" appearance, along with the specific vessel segments involved and the timing of these occurrences. Ultimately, the physician documents the findings and interprets the results, culminating in a detailed written report that outlines the outcomes of the study.
© Copyright 2025 Coding Ahead. All rights reserved.
The transcranial Doppler study coded as CPT® 93893 is indicated for the following conditions:
The procedure for a transcranial Doppler study involves several critical steps to ensure accurate detection of venous-arterial shunts:
Post-procedure care for a transcranial Doppler study typically involves monitoring the patient for any immediate adverse reactions to the intravenous injection. The physician will review the results and discuss the findings with the patient, ensuring that any necessary follow-up actions or additional testing are clearly communicated. The written report generated from the study will serve as a critical component of the patient's medical record, guiding further clinical decision-making and management.
| Short Descr | TCD STD ICR ART VEN-ART SHNT | Medium Descr | TCD STD ICR ART VEN-ARTL SHNT DETCJ IV MBUBB NJX | Long Descr | Transcranial Doppler study of the intracranial arteries; venous-arterial shunt detection with 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 |
| 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. | 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 | 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). | 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). | 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 | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | 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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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2005-01-01 | Added | First appearance in code book in 2005. |
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