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Colleen, I did this exam in a private office with a complete TCD,
monotoring and with BH. I only have access to a TCD nonimaging system. I
did studies in the past with maneuvering so added it to the exam. So the
end result is I cannot bill for the exam since we charged for all the exams
that I mentioned.
Thank you and great to hear from an expert.
My best to you and staff at Swedish.
On Oct 29, 2012 9:09 AM, "Douville, Colleen" <[log in to unmask]>
wrote:

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> Denise,****
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> Charges depend on your protocol.  A limited carotid to assess the
> extracranial vertebral arteries bilaterally should be performed since
> patients who are positive frequently only have one functional vertebral,
> the other either occluded/severely stenosed or congenitally small.  A
> limited TCD is also performed to assess the intracranial vertebral and
> basilar arteries. TCD *Imaging* of the posterior cerebral arteries will
> help rule out fetal origin PCA’s which, if present will preclude doing the
> study at all (unless you try to monitor the extracranial verterbral
> arteries during head positioning).  The bilateral PCA’s are then monitoring
> using a head band with provocative head positioning.  This is a tedious
> test indeed but for the few patients who have this syndrome can definitely
> direct their management and if done correctly rule out extrinsic
> compression.  We charge a limited carotid and a limited TCD.  Below is a
> good reference article; I tried to attach it but the Flownet rejected the
> email because of the attachment.****
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> *Dynamic Transcranial Doppler Assessment of*
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> *Positional Vertebrobasilar Ischemia*
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> Matthias Sturzenegger, MD; David W. Newell, MD; Colleen Douville, BA, RVT;
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> Sheila Byrd, RVT; Ketti Schoonover, BS, RVT****
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> *(Stroke. **1994^5:1776-1783.)*****
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> Colleen Douville ****
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> Director *l *Cerebrovascular Ultrasound****
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> Program Manager *l *Epilepsy & Clinical Neurophysiology****
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> [log in to unmask]****
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> Office:    206-320-4080****
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> Cell:        206-601-8077****
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> Swedish Neuroscience Institute****
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> 500 17th Ave l 4 West, Room 400****
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> Seattle l WA l 98122****
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> [image: Description: SwedishNeuro-2c-h]****
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> *From:* UVM Flownet [mailto:[log in to unmask]] *On Behalf Of *Denise
> Levy
> *Sent:* Friday, October 26, 2012 4:54 PM
> *To:* [log in to unmask]
> *Subject:* TCD CHARGE. vertebral artery****
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> Hi, Vertebral TCD with head maneuvering to bring out dizziness.  Charge in
> addition to other exama done the same day.
> TCD COMP 93886
> VASOREACT 93890
> MONITORING 93892
> NECK AND HEAD POSITIONING 4 DOPPLER EACH SIDE. ? additional charge.
> Thank you,
> Denise****
>
> To unsubscribe or search other topics on UVM Flownet link to:
> http://list.uvm.edu/archives/uvmflownet.html ****
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