Neurovascular Diagnostic Exams

Neurovascular TCD exams provide dynamic visualization of blood flow velocities and direction of flow in cerebral arteries. These exams are frequently used in conjunction with other imaging modalities to add real time blood flow monitoring through stenotic regions or in hemorrhagic vessels. The digital power M-Mode allows the operator to rapidly find windows and to see 64 mm of depth in a single view. This study is reimbursable under CPT code 93886, TCD - Complete Exam.

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PFO Detection

Contrast TCD utilizing a measured Valsalva maneuver is an easy to perform test to detect Patent Foramen Ovale (PFO) and other right to left shunts. One of the advantages of TCD over TEE is the patient’s ability to perform an adequate valsalva strain. Utilizing the Spencer Technologies ST3 and Marc series headframe, the PFO/RLS test becomes a very straight forward study lasting generally less than 30 minutes. This study is reimbursable under CPT code 93893, TCD, Emboli detection with injection (Bubble Study).

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Vasospasm (VSP) Monitoring

TCD has been shown to be effective in monitoring day to day velocity changes in cerebral circulation post cerebral aneurysm rupture or neuro-radiologic intervention. The Spencer Technologies ST3 has a high pulse repetition frequency (PRF) to accurately measure high blood flow velocities that are common with vasospasm. Additionally The Spencer Technologies ST3 has a unique multiday trend report specifically designed for tracking and reporting vasospasm. This study is reimbursable under CPT code 93888, TCD - Limited Exam.

Embolic Monitoring

Power M-mode is a valuable tool in detecting cerebral micro emboli (blood clot or air bubbles) due to a variety of pathologies including fibrillation or prosthetic valves. Another application for embolic monitoring is to identify asymptomatic carotid stenosis patients at high risk for stroke. With the Spencer Technologies HDO digital M-Mode, “embolic tracks” can be differentiated from artifact. This study is reimbursable under CPT code 93892, TCD, Emboli detection w/o injection.

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Intra-Operative Monitoring

Transcranial Doppler (TCD) is frequently used to monitor cerebral arteries for emboli and real time blood flow velocities during surgical procedures such as carotid endarterectomy, coronary artery bypass grafting and cerebral/carotid angioplasty or stenting. The Spencer Technologies’ patented Power M-Mode display is a highly sensitive method of detecting cerebral emboli. This study is reimbursable under CPT code 93892, TCD, Emboli detection w/o injection.

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Vaso-Motor Reactivity

The ability of cerebral blood vessels to adapt to changes in metabolic demands of the brain can be measured using Transcranial Doppler. Stimuli such as CO2 inhalation, breath holding or the administration of acetazolamide will typically cause a vasodilatory response. This response can be measured by monitoring blood flow velocity changes with TCD. Patients whose vasomotor reserve is exhausted may be at risk for stroke or may not be candidates for some surgeries. This study is reimbursable under CPT code 93890, TCD Vasoreactivity Study.

Sickle Cell Anemia

TCD screening of children with sickle cell disease between the ages of 2 and 16 years has been proven effective for assessing stroke risk. The time-averaged mean maximum blood flow velocity of > 200 cm/s in the ICA or MCA by TCD is has been associated with stroke. In one study, transfusing these patients based on their blood flow velocity measurements resulted in a 92% reduction in stroke. This study is reimbursable under CPT code 93888, TCD - Limited or 93886, TCD - Complete Exam.

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Lytic therapy

Lytic therapy for cerebral blood vessels can be monitored with Transcranial Doppler to determine the point at which reperfusion occurs. This can help moderate the dosage of the lytic agent and reduce the risk of bleeding. While recent studies have suggested that the use of TCD may reduce the time to reprofusion, the therapeutic aspect of TCD remains under investigation. This study is reimbursable under CPT code 93888, TCD - Limited Exam.

Brain Death

Brain death is a clinical diagnosis and brain death exams performed with TCD are used as confirmatory tests. Using the Spencer Technologies ST3 for patients who are thought to be moving toward that diagnosis can help in the planning of other more costly exams and the use of TCD is especially helpful in examining patients on barbiturate therapy.This study is reimbursable under CPT code 93888, TCD - Limited or 93886, TCD - Complete Exam.

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