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:

 

 

 

 

 

Denise,

 

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.

 

Dynamic Transcranial Doppler Assessment of

Positional Vertebrobasilar Ischemia

Matthias Sturzenegger, MD; David W. Newell, MD; Colleen Douville, BA, RVT;

Sheila Byrd, RVT; Ketti Schoonover, BS, RVT

(Stroke. 1994^5:1776-1783.)

 

Colleen Douville

Director l Cerebrovascular Ultrasound

Program Manager l Epilepsy & Clinical Neurophysiology

[log in to unmask]

Office:    206-320-4080

Cell:        206-601-8077

 

Swedish Neuroscience Institute

500 17th Ave l 4 West, Room 400

Seattle l WA l 98122

 

[log in to unmask]" alt="Description: SwedishNeuro-2c-h">

 

 

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

 

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

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