LCD Reference Article Billing and Coding Article

Billing and Coding: Non-Invasive Cerebrovascular Studies

A57592

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Source Article ID
N/A
Article ID
A57592
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Non-Invasive Cerebrovascular Studies
Article Type
Billing and Coding
Original Effective Date
11/01/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A

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Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Italicized font represents CMS national NCD language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national NCD language/wording.

Title XVIII of the Social Security Act section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act section 1862 (a) (1) (A) allows coverage and payment of those items or services that are considered to be medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act section 1862 (a) (1) (D) excludes Medicare payment for any expenses incurred for items or services that are investigational or experimental.

Title XVIII of the Social Security Act section 1862 (a) (7) excludes routine physical examinations and services from Medicare coverage.

42 CFR, Section 410.32 (a) Diagnosis x-ray tests, diagnostic laboratory tests, and other diagnostic tests indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician or other qualified non-physician provider who is treating the patient are not reasonable and necessary (see 42 CFR 411.15(k) (1).

42 CFR, Section 410.32 (b) Diagnostic x-ray and other diagnostic tests. (1) Basic rule. .. all diagnostic x-ray and other diagnostic tests covered under section 1861(s)(3) of the Act and payable under the physician fee schedule must be furnished under the appropriate level of supervision by a physician as defined in section 1861® of the Act. Services furnished without the required level of supervision are not reasonable and necessary. (see 42 CFR 411.15(k)(1)).

CMS Pub 100-02 Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, Section 80 – Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic Tests.

CMS Pub 100-03 Medicare National Coverage Determinations Manual, Chapter 1 – Coverage Determinations Part 1, Section 20.17 - Noninvasive Tests of Carotid Function.
Part 4, Sections
220.5 - Ultrasound Diagnostic Procedures and
300.1 - Obsolete or Unreliable Diagnostic Tests.

CMS Pub 100-04 Medicare Claims Processing Manual, Chapter 13 – Radiology Services and Other Diagnostic Procedures, Sections –
10.1 - Billing Part B Radiology Services and Other Diagnostic Procedures and
20 – Payment Conditions for Radiology Services.
Chapter 16 – Laboratory Services, Section 40.2 – Payment Limit for Purchased Services.

CMS Pub 100-08, Medicare Program Integrity Manual, Chapter 13 – Local Coverage Determinations, Section 13.5.1 – Reasonable and Necessary Provisions in LCDs.

CMS Publication 100-09, Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5 - Correct Coding Initiative.

Article Guidance

Article Text

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the related LCD.

Documentation Requirements
Adequate documentation is essential for high-quality patient care and to demonstrate the reasonableness and medical necessity of the study(ies). Documentation must support the criteria for coverage as described in the Coverage Indications, Limitations, and/or Medical Necessity section of this LCD. There should be a permanent record of the studies performed and the interpretation. The documentation should include a description of the studies performed and any contrast media and/or radiopharmaceuticals used. Any known significant patient reaction or complications should be recorded. Comparison with prior relevant studies needs to be addressed in the documentation along with both normal and abnormal findings. Variations from normal should be documented along with the measurements. The report should address or answer any specific clinical questions. If there are factors that prevent answering the clinical questions, this should be explained in the documentation. Retention of the ultrasound examination images should be consistent both with clinical need and with relevant legal and local health care facility requirements.

If the provider of the study is other than the ordering/referring physician/nonphysician practitioner, that provider must maintain a copy of the test results and interpretation, along with copies of the ordering/referring physician/nonphysician practitioner’s order for the studies. This order is required to provide adequate diagnostic information to the performing provider. The physician/nonphysician practitioner must state the clinical indication/medical necessity for the study in his/her order for the test. The provider is responsible for ensuring the medical necessity of procedures and maintaining the medical record, which must be available to Medicare upon request. Results of all testing must be shared with the referring physician. Non-invasive vascular studies are medically reasonable and medically necessary only if the outcomes will be utilized in the clinical management of the patient.

Documentation must be provided supporting the need for more than one imaging study or a repeat preoperative scan.

Utilization Guidelines
Each patient’s condition and response to treatment must medically warrant the number of services reported for payment. Medicare requires the medical necessity for each study reported to be clearly documented in the patient’s medical record.

Frequency of follow-up studies will be carefully monitored for medical necessity, and it is the responsibility of the physician/provider to maintain documentation of medical necessity in the patient’s medical record.

Only one Doppler preoperative scan is considered reasonable and necessary for bypass surgery. If a more current preoperative scan is indicated for a patient with multiple comorbidities having difficulty being stabilized for surgery or a change in condition, the medical record would need to support the medical necessity of the second scan.

Re-evaluation of existing carotid stenosis. Patients demonstrating a diameter reduction of greater than 50% with symptoms and those patients with > 60% with no symptoms are normally followed on an annual basis. If patients become symptomatic of carotid disease repeat duplex scans are allowed without regard to the above schedule.

Follow-up after a carotid endarterectomy (outside the global period). These patients are normally followed with duplex ultrasonography on the affected side at 6 weeks, 6 months, and annually thereafter unless symptoms develop. During the first year, follow-up studies should be on the ipsilateral side unless signs and symptoms or previously identified disease in the contralateral carotid artery provide indications for a bilateral procedure.

Multiple cerebrovascular procedures may be allowed during the same encounter given the physician/non-physician can demonstrate medical necessity as documented in the patient’s medical record.

Preventive and/or screening services unless covered in Statute are not covered by Medicare.

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Coding Information

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(338 Codes)
Group 1 Paragraph

Extracranial Arteries Studies (93880, 93882)
Use a diagnosis code of R22.1 (localized swelling, mass, and lump, neck) to report pulsatile neck mass.

Use a diagnosis code of R09.89 (Other specified symptoms and signs involving the circulatory and respiratory systems) to report a carotid bruit.

For codes in the table below that require a 7th character, letter A initial encounter, D subsequent encounter, or S sequela may be used.

Group 1 Codes
Code Description
G04.1 Tropical spastic paraplegia
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.3 Amaurosis fugax
G45.4 Transient global amnesia
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
G81.01 Flaccid hemiplegia affecting right dominant side
G81.02 Flaccid hemiplegia affecting left dominant side
G81.03 Flaccid hemiplegia affecting right nondominant side
G81.04 Flaccid hemiplegia affecting left nondominant side
G81.11 Spastic hemiplegia affecting right dominant side
G81.12 Spastic hemiplegia affecting left dominant side
G81.13 Spastic hemiplegia affecting right nondominant side
G81.14 Spastic hemiplegia affecting left nondominant side
G81.91 Hemiplegia, unspecified affecting right dominant side
G81.92 Hemiplegia, unspecified affecting left dominant side
G81.93 Hemiplegia, unspecified affecting right nondominant side
G81.94 Hemiplegia, unspecified affecting left nondominant side
G82.21 Paraplegia, complete
G82.22 Paraplegia, incomplete
G82.51 Quadriplegia, C1-C4 complete
G82.52 Quadriplegia, C1-C4 incomplete
G82.53 Quadriplegia, C5-C7 complete
G82.54 Quadriplegia, C5-C7 incomplete
G83.0 Diplegia of upper limbs
G83.11 Monoplegia of lower limb affecting right dominant side
G83.12 Monoplegia of lower limb affecting left dominant side
G83.13 Monoplegia of lower limb affecting right nondominant side
G83.14 Monoplegia of lower limb affecting left nondominant side
G83.21 Monoplegia of upper limb affecting right dominant side
G83.22 Monoplegia of upper limb affecting left dominant side
G83.23 Monoplegia of upper limb affecting right nondominant side
G83.24 Monoplegia of upper limb affecting left nondominant side
G83.31 Monoplegia, unspecified affecting right dominant side
G83.32 Monoplegia, unspecified affecting left dominant side
G83.33 Monoplegia, unspecified affecting right nondominant side
G83.34 Monoplegia, unspecified affecting left nondominant side
G83.9 Paralytic syndrome, unspecified
G97.31 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating a nervous system procedure
G97.32 Intraoperative hemorrhage and hematoma of a nervous system organ or structure complicating other procedure
G97.48 Accidental puncture and laceration of other nervous system organ or structure during a nervous system procedure
G97.49 Accidental puncture and laceration of other nervous system organ or structure during other procedure
G97.51 Postprocedural hemorrhage of a nervous system organ or structure following a nervous system procedure
G97.52 Postprocedural hemorrhage of a nervous system organ or structure following other procedure
H34.01 Transient retinal artery occlusion, right eye
H34.02 Transient retinal artery occlusion, left eye
H34.03 Transient retinal artery occlusion, bilateral
H34.11 Central retinal artery occlusion, right eye
H34.12 Central retinal artery occlusion, left eye
H34.13 Central retinal artery occlusion, bilateral
H34.211 Partial retinal artery occlusion, right eye
H34.212 Partial retinal artery occlusion, left eye
H34.213 Partial retinal artery occlusion, bilateral
H34.231 Retinal artery branch occlusion, right eye
H34.232 Retinal artery branch occlusion, left eye
H34.233 Retinal artery branch occlusion, bilateral
H34.8110 Central retinal vein occlusion, right eye, with macular edema
H34.8111 Central retinal vein occlusion, right eye, with retinal neovascularization
H34.8112 Central retinal vein occlusion, right eye, stable
H34.8120 Central retinal vein occlusion, left eye, with macular edema
H34.8121 Central retinal vein occlusion, left eye, with retinal neovascularization
H34.8122 Central retinal vein occlusion, left eye, stable
H34.8130 Central retinal vein occlusion, bilateral, with macular edema
H34.8131 Central retinal vein occlusion, bilateral, with retinal neovascularization
H34.8132 Central retinal vein occlusion, bilateral, stable
H34.821 Venous engorgement, right eye
H34.822 Venous engorgement, left eye
H34.823 Venous engorgement, bilateral
H34.8310 Tributary (branch) retinal vein occlusion, right eye, with macular edema
H34.8311 Tributary (branch) retinal vein occlusion, right eye, with retinal neovascularization
H34.8312 Tributary (branch) retinal vein occlusion, right eye, stable
H34.8320 Tributary (branch) retinal vein occlusion, left eye, with macular edema
H34.8321 Tributary (branch) retinal vein occlusion, left eye, with retinal neovascularization
H34.8322 Tributary (branch) retinal vein occlusion, left eye, stable
H34.8330 Tributary (branch) retinal vein occlusion, bilateral, with macular edema
H34.8331 Tributary (branch) retinal vein occlusion, bilateral, with retinal neovascularization
H34.8332 Tributary (branch) retinal vein occlusion, bilateral, stable
H34.9 Unspecified retinal vascular occlusion
H35.061 Retinal vasculitis, right eye
H35.062 Retinal vasculitis, left eye
H35.063 Retinal vasculitis, bilateral
H35.82 Retinal ischemia
H47.011 Ischemic optic neuropathy, right eye
H47.012 Ischemic optic neuropathy, left eye
H47.013 Ischemic optic neuropathy, bilateral
H53.121 Transient visual loss, right eye
H53.122 Transient visual loss, left eye
H53.123 Transient visual loss, bilateral
H53.131 Sudden visual loss, right eye
H53.132 Sudden visual loss, left eye
H53.133 Sudden visual loss, bilateral
H53.431 Sector or arcuate defects, right eye
H53.432 Sector or arcuate defects, left eye
H53.433 Sector or arcuate defects, bilateral
H53.451 Other localized visual field defect, right eye
H53.452 Other localized visual field defect, left eye
H53.453 Other localized visual field defect, bilateral
H53.461 Homonymous bilateral field defects, right side
H53.462 Homonymous bilateral field defects, left side
H53.47 Heteronymous bilateral field defects
H53.481 Generalized contraction of visual field, right eye
H53.482 Generalized contraction of visual field, left eye
H53.483 Generalized contraction of visual field, bilateral
H81.01 Meniere's disease, right ear
H81.02 Meniere's disease, left ear
H81.03 Meniere's disease, bilateral
H81.4 Vertigo of central origin
H93.A1 Pulsatile tinnitus, right ear
H93.A2 Pulsatile tinnitus, left ear
H93.A3 Pulsatile tinnitus, bilateral
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.211 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212 Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213 Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.22 Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231 Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232 Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233 Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.29 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.511 Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512 Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513 Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.521 Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522 Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523 Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.531 Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532 Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533 Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.541 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542 Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.0 Dissection of cerebral arteries, nonruptured
I67.1 Cerebral aneurysm, nonruptured
I67.2 Cerebral atherosclerosis
I67.4 Hypertensive encephalopathy
I67.6 Nonpyogenic thrombosis of intracranial venous system
I67.7 Cerebral arteritis, not elsewhere classified
I67.81 Acute cerebrovascular insufficiency
I67.82 Cerebral ischemia
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I67.89 Other cerebrovascular disease
I68.2 Cerebral arteritis in other diseases classified elsewhere
I69.020 Aphasia following nontraumatic subarachnoid hemorrhage
I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage
I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage
I69.023 Fluency disorder following nontraumatic subarachnoid hemorrhage
I69.090 Apraxia following nontraumatic subarachnoid hemorrhage
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage
I69.093 Ataxia following nontraumatic subarachnoid hemorrhage
I69.120 Aphasia following nontraumatic intracerebral hemorrhage
I69.121 Dysphasia following nontraumatic intracerebral hemorrhage
I69.122 Dysarthria following nontraumatic intracerebral hemorrhage
I69.123 Fluency disorder following nontraumatic intracerebral hemorrhage
I69.190 Apraxia following nontraumatic intracerebral hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.192 Facial weakness following nontraumatic intracerebral hemorrhage
I69.193 Ataxia following nontraumatic intracerebral hemorrhage
I69.220 Aphasia following other nontraumatic intracranial hemorrhage
I69.221 Dysphasia following other nontraumatic intracranial hemorrhage
I69.222 Dysarthria following other nontraumatic intracranial hemorrhage
I69.223 Fluency disorder following other nontraumatic intracranial hemorrhage
I69.290 Apraxia following other nontraumatic intracranial hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.292 Facial weakness following other nontraumatic intracranial hemorrhage
I69.293 Ataxia following other nontraumatic intracranial hemorrhage
I69.320 Aphasia following cerebral infarction
I69.321 Dysphasia following cerebral infarction
I69.322 Dysarthria following cerebral infarction
I69.323 Fluency disorder following cerebral infarction
I69.351 Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side
I69.352 Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side
I69.353 Hemiplegia and hemiparesis following cerebral infarction affecting right non-dominant side
I69.354 Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side
I69.390 Apraxia following cerebral infarction
I69.391 Dysphagia following cerebral infarction
I69.392 Facial weakness following cerebral infarction
I69.393 Ataxia following cerebral infarction
I69.820 Aphasia following other cerebrovascular disease
I69.821 Dysphasia following other cerebrovascular disease
I69.822 Dysarthria following other cerebrovascular disease
I69.823 Fluency disorder following other cerebrovascular disease
I69.890 Apraxia following other cerebrovascular disease
I69.891 Dysphagia following other cerebrovascular disease
I69.892 Facial weakness following other cerebrovascular disease
I69.893 Ataxia following other cerebrovascular disease
I72.0 Aneurysm of carotid artery
I72.6 Aneurysm of vertebral artery
I77.71 Dissection of carotid artery
I77.74 Dissection of vertebral artery
I97.810 Intraoperative cerebrovascular infarction during cardiac surgery
I97.811 Intraoperative cerebrovascular infarction during other surgery
I97.820 Postprocedural cerebrovascular infarction following cardiac surgery
I97.821 Postprocedural cerebrovascular infarction following other surgery
L76.22 Postprocedural hemorrhage of skin and subcutaneous tissue following other procedure
M30.0 Polyarteritis nodosa
M30.1 Polyarteritis with lung involvement [Churg-Strauss]
M30.2 Juvenile polyarteritis
M30.8 Other conditions related to polyarteritis nodosa
M31.10 Thrombotic microangiopathy, unspecified
M31.11 Hematopoietic stem cell transplantation-associated thrombotic microangiopathy [HSCT-TMA]
M31.19 Other thrombotic microangiopathy
M31.30 Wegener's granulomatosis without renal involvement
M31.31 Wegener's granulomatosis with renal involvement
M31.4 Aortic arch syndrome [Takayasu]
M31.5 Giant cell arteritis with polymyalgia rheumatica
M31.6 Other giant cell arteritis
M31.7 Microscopic polyangiitis
R09.89 Other specified symptoms and signs involving the circulatory and respiratory systems
R22.0 Localized swelling, mass and lump, head
R22.1 Localized swelling, mass and lump, neck
R26.0 Ataxic gait
R26.1 Paralytic gait
R26.81 Unsteadiness on feet
R26.89 Other abnormalities of gait and mobility
R27.8 Other lack of coordination
R29.5 Transient paralysis
R29.810 Facial weakness
R42 Dizziness and giddiness
R47.01 Aphasia
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.89 Other speech disturbances
R55 Syncope and collapse
S09.0XXA Injury of blood vessels of head, not elsewhere classified, initial encounter
S15.011A Minor laceration of right carotid artery, initial encounter
S15.012A Minor laceration of left carotid artery, initial encounter
S15.021A Major laceration of right carotid artery, initial encounter
S15.022A Major laceration of left carotid artery, initial encounter
S15.091A Other specified injury of right carotid artery, initial encounter
S15.092A Other specified injury of left carotid artery, initial encounter
S15.111A Minor laceration of right vertebral artery, initial encounter
S15.112A Minor laceration of left vertebral artery, initial encounter
S15.121A Major laceration of right vertebral artery, initial encounter
S15.122A Major laceration of left vertebral artery, initial encounter
S15.191A Other specified injury of right vertebral artery, initial encounter
S15.192A Other specified injury of left vertebral artery, initial encounter
S15.211A Minor laceration of right external jugular vein, initial encounter
S15.212A Minor laceration of left external jugular vein, initial encounter
S15.221A Major laceration of right external jugular vein, initial encounter
S15.222A Major laceration of left external jugular vein, initial encounter
S15.291A Other specified injury of right external jugular vein, initial encounter
S15.292A Other specified injury of left external jugular vein, initial encounter
S15.311A Minor laceration of right internal jugular vein, initial encounter
S15.312A Minor laceration of left internal jugular vein, initial encounter
S15.321A Major laceration of right internal jugular vein, initial encounter
S15.322A Major laceration of left internal jugular vein, initial encounter
S15.391A Other specified injury of right internal jugular vein, initial encounter
S15.392A Other specified injury of left internal jugular vein, initial encounter
S15.8XXA Injury of other specified blood vessels at neck level, initial encounter
S25.111A Minor laceration of right innominate or subclavian artery, initial encounter
S25.112A Minor laceration of left innominate or subclavian artery, initial encounter
S25.121A Major laceration of right innominate or subclavian artery, initial encounter
S25.122A Major laceration of left innominate or subclavian artery, initial encounter
S25.191A Other specified injury of right innominate or subclavian artery, initial encounter
S25.192A Other specified injury of left innominate or subclavian artery, initial encounter
T82.311A Breakdown (mechanical) of carotid arterial graft (bypass), initial encounter
T82.321A Displacement of carotid arterial graft (bypass), initial encounter
T82.331A Leakage of carotid arterial graft (bypass), initial encounter
T82.391A Other mechanical complication of carotid arterial graft (bypass), initial encounter
Z01.810 Encounter for preprocedural cardiovascular examination
Z01.818 Encounter for other preprocedural examination
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits

Group 2

(159 Codes)
Group 2 Paragraph

Transcranial Doppler Testing (93886, 93888, 93890, 93892, 93893)

Group 2 Codes
Code Description
D57.00 Hb-SS disease with crisis, unspecified
D57.01 Hb-SS disease with acute chest syndrome
D57.02 Hb-SS disease with splenic sequestration
D57.03 Hb-SS disease with cerebral vascular involvement
D57.04 Hb-SS disease with dactylitis
D57.09 Hb-SS disease with crisis with other specified complication
D57.1 Sickle-cell disease without crisis
D57.20 Sickle-cell/Hb-C disease without crisis
D57.211 Sickle-cell/Hb-C disease with acute chest syndrome
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.213 Sickle-cell/Hb-C disease with cerebral vascular involvement
D57.214 Sickle-cell/Hb-C disease with dactylitis
D57.218 Sickle-cell/Hb-C disease with crisis with other specified complication
D57.219 Sickle-cell/Hb-C disease with crisis, unspecified
D57.40 Sickle-cell thalassemia without crisis
D57.411 Sickle-cell thalassemia, unspecified, with acute chest syndrome
D57.412 Sickle-cell thalassemia, unspecified, with splenic sequestration
D57.413 Sickle-cell thalassemia, unspecified, with cerebral vascular involvement
D57.414 Sickle-cell thalassemia, unspecified, with dactylitis
D57.418 Sickle-cell thalassemia, unspecified, with crisis with other specified complication
D57.419 Sickle-cell thalassemia, unspecified, with crisis
D57.42 Sickle-cell thalassemia beta zero without crisis
D57.431 Sickle-cell thalassemia beta zero with acute chest syndrome
D57.432 Sickle-cell thalassemia beta zero with splenic sequestration
D57.433 Sickle-cell thalassemia beta zero with cerebral vascular involvement
D57.434 Sickle-cell thalassemia beta zero with dactylitis
D57.438 Sickle-cell thalassemia beta zero with crisis with other specified complication
D57.439 Sickle-cell thalassemia beta zero with crisis, unspecified
D57.44 Sickle-cell thalassemia beta plus without crisis
D57.451 Sickle-cell thalassemia beta plus with acute chest syndrome
D57.452 Sickle-cell thalassemia beta plus with splenic sequestration
D57.453 Sickle-cell thalassemia beta plus with cerebral vascular involvement
D57.454 Sickle-cell thalassemia beta plus with dactylitis
D57.458 Sickle-cell thalassemia beta plus with crisis with other specified complication
D57.459 Sickle-cell thalassemia beta plus with crisis, unspecified
D57.80 Other sickle-cell disorders without crisis
D57.811 Other sickle-cell disorders with acute chest syndrome
D57.812 Other sickle-cell disorders with splenic sequestration
D57.813 Other sickle-cell disorders with cerebral vascular involvement
D57.814 Other sickle-cell disorders with dactylitis
D57.818 Other sickle-cell disorders with crisis with other specified complication
D57.819 Other sickle-cell disorders with crisis, unspecified
G45.0 Vertebro-basilar artery syndrome
G45.1 Carotid artery syndrome (hemispheric)
G45.2 Multiple and bilateral precerebral artery syndromes
G45.4 Transient global amnesia
G45.8 Other transient cerebral ischemic attacks and related syndromes
G46.0 Middle cerebral artery syndrome
G46.1 Anterior cerebral artery syndrome
G46.2 Posterior cerebral artery syndrome
G93.82 Brain death
I60.01 Nontraumatic subarachnoid hemorrhage from right carotid siphon and bifurcation
I60.02 Nontraumatic subarachnoid hemorrhage from left carotid siphon and bifurcation
I60.11 Nontraumatic subarachnoid hemorrhage from right middle cerebral artery
I60.12 Nontraumatic subarachnoid hemorrhage from left middle cerebral artery
I60.2 Nontraumatic subarachnoid hemorrhage from anterior communicating artery
I60.31 Nontraumatic subarachnoid hemorrhage from right posterior communicating artery
I60.32 Nontraumatic subarachnoid hemorrhage from left posterior communicating artery
I60.4 Nontraumatic subarachnoid hemorrhage from basilar artery
I60.51 Nontraumatic subarachnoid hemorrhage from right vertebral artery
I60.52 Nontraumatic subarachnoid hemorrhage from left vertebral artery
I60.6 Nontraumatic subarachnoid hemorrhage from other intracranial arteries
I60.8 Other nontraumatic subarachnoid hemorrhage
I61.0 Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
I61.1 Nontraumatic intracerebral hemorrhage in hemisphere, cortical
I61.3 Nontraumatic intracerebral hemorrhage in brain stem
I61.4 Nontraumatic intracerebral hemorrhage in cerebellum
I61.5 Nontraumatic intracerebral hemorrhage, intraventricular
I61.6 Nontraumatic intracerebral hemorrhage, multiple localized
I61.8 Other nontraumatic intracerebral hemorrhage
I62.01 Nontraumatic acute subdural hemorrhage
I62.02 Nontraumatic subacute subdural hemorrhage
I62.03 Nontraumatic chronic subdural hemorrhage
I62.1 Nontraumatic extradural hemorrhage
I63.011 Cerebral infarction due to thrombosis of right vertebral artery
I63.012 Cerebral infarction due to thrombosis of left vertebral artery
I63.013 Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.02 Cerebral infarction due to thrombosis of basilar artery
I63.031 Cerebral infarction due to thrombosis of right carotid artery
I63.032 Cerebral infarction due to thrombosis of left carotid artery
I63.033 Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.09 Cerebral infarction due to thrombosis of other precerebral artery
I63.111 Cerebral infarction due to embolism of right vertebral artery
I63.112 Cerebral infarction due to embolism of left vertebral artery
I63.113 Cerebral infarction due to embolism of bilateral vertebral arteries
I63.12 Cerebral infarction due to embolism of basilar artery
I63.131 Cerebral infarction due to embolism of right carotid artery
I63.132 Cerebral infarction due to embolism of left carotid artery
I63.133 Cerebral infarction due to embolism of bilateral carotid arteries
I63.19 Cerebral infarction due to embolism of other precerebral artery
I63.311 Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312 Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313 Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.321 Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322 Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323 Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.331 Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332 Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333 Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.341 Cerebral infarction due to thrombosis of right cerebellar artery
I63.342 Cerebral infarction due to thrombosis of left cerebellar artery
I63.343 Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.39 Cerebral infarction due to thrombosis of other cerebral artery
I63.411 Cerebral infarction due to embolism of right middle cerebral artery
I63.412 Cerebral infarction due to embolism of left middle cerebral artery
I63.413 Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.421 Cerebral infarction due to embolism of right anterior cerebral artery
I63.422 Cerebral infarction due to embolism of left anterior cerebral artery
I63.423 Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.431 Cerebral infarction due to embolism of right posterior cerebral artery
I63.432 Cerebral infarction due to embolism of left posterior cerebral artery
I63.433 Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.441 Cerebral infarction due to embolism of right cerebellar artery
I63.442 Cerebral infarction due to embolism of left cerebellar artery
I63.443 Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.49 Cerebral infarction due to embolism of other cerebral artery
I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81 Other cerebral infarction due to occlusion or stenosis of small artery
I63.89 Other cerebral infarction
I65.01 Occlusion and stenosis of right vertebral artery
I65.02 Occlusion and stenosis of left vertebral artery
I65.03 Occlusion and stenosis of bilateral vertebral arteries
I65.1 Occlusion and stenosis of basilar artery
I65.21 Occlusion and stenosis of right carotid artery
I65.22 Occlusion and stenosis of left carotid artery
I65.23 Occlusion and stenosis of bilateral carotid arteries
I65.8 Occlusion and stenosis of other precerebral arteries
I66.01 Occlusion and stenosis of right middle cerebral artery
I66.02 Occlusion and stenosis of left middle cerebral artery
I66.03 Occlusion and stenosis of bilateral middle cerebral arteries
I66.11 Occlusion and stenosis of right anterior cerebral artery
I66.12 Occlusion and stenosis of left anterior cerebral artery
I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries
I66.21 Occlusion and stenosis of right posterior cerebral artery
I66.22 Occlusion and stenosis of left posterior cerebral artery
I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries
I66.3 Occlusion and stenosis of cerebellar arteries
I66.8 Occlusion and stenosis of other cerebral arteries
I67.1 Cerebral aneurysm, nonruptured
I67.2 Cerebral atherosclerosis
I67.4 Hypertensive encephalopathy
I67.6 Nonpyogenic thrombosis of intracranial venous system
I67.7 Cerebral arteritis, not elsewhere classified
I67.81 Acute cerebrovascular insufficiency
I67.82 Cerebral ischemia
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
I67.89 Other cerebrovascular disease
Q28.0 Arteriovenous malformation of precerebral vessels
Q28.1 Other malformations of precerebral vessels
Q28.2 Arteriovenous malformation of cerebral vessels
Q28.3 Other malformations of cerebral vessels
Q28.8 Other specified congenital malformations of circulatory system
Z01.810 Encounter for preprocedural cardiovascular examination
Z01.818 Encounter for other preprocedural examination
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z48.812 Encounter for surgical aftercare following surgery on the circulatory system
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ICD-10-CM Codes that DO NOT Support Medical Necessity

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Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R5

Posted 09/28/2023 Under ICD-10 Codes that Support Medical Necessity Group 2 Codes added: D57.04, D57.214, D57.414, D57.434, D57.454, D57.814. These updates were made due to the annual ICD-10-CM code update and are effective 10/01/2023. Review completed 09/05/2023.

10/01/2021 R4

09/30/2021 ICD-10 CM Code annual update. Under ICD-10 Codes that Support Medical Necessity Group 1: Codes Deleted M31.1. Added M31.10, M31.11, M31.19. Review completed 08/18/2021.

10/01/2020 R3

11/26/2020 The following codes were added to Group 2 with the last revision but were inadvertently left out of the revision history statement: D57.03 and D57.09.

10/01/2020 R2

10/01/2020 ICD-10-CM Code Updates to Group 2: Added D57.213, D57.218, D57.413, D57.418, D57.42, D57.431, D57.432, D57.433, D57.438, D57.439, D57.44, D57.451, D57.452, D57.453, D57.458, D57.459, D57.813, D57.818. The following had description changes: D57.411, D57.412, D57.419.

07/30/2020 R1

07/30/2020 Added ICD 10 code I67.848 to Group 2 Paragraph, Group 2 Codes per a provider request.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
SAD Process URL 1
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SAD Process URL 2
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Public Versions
Updated On Effective Dates Status
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Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

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