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6.01.01ARCHIVADA DOPPLER TRANSCRANEAL
SecciónRadiología Fecha Original: 14 de septiembre de 1999
SubsecciónRadiología Fecha Revisión23 de junio de 2017
“Esta política está protegida por derechos de autor bajo las leyes federales y/o las leyes de propiedad intelectual y las de regulaciones estatales. Ninguna parte de esta publicación puede ser reproducida, almacenada en un sistema de recuperación, transmitida en cualquier forma o por cualquier medio, sea electrónico, mecánico, fotocopia, grabación o cualquier otro, sin el permiso escrito del plan de salud.”

Definición


El Doppler Transcraneal es una tecnología de ultra sonido que usa frecuencias bajas (de 1 a 2 Mhz) para poder grabar la velocidad del torrente sanguíneo en arterias y venas intracraneales según circula la sangre a través de las foráminas craneales.
La exactitud en la interpretación de datos de Doppler Transcraneal depende de los conocimientos, experiencia y destreza del tecnólogo y del intérprete.
El Doppler Transcraneal es tecnología no invasiva, segura, es un procedimiento aceptado. Se puede repetir con frecuencia y su valor está establecido.
Política
El Doppler Transcraneal se considera para pago en:
  • Monitoreo del vasoespasmo en pacientes con hemorragia subaracnoidea.

  • Para la evaluación inicial de la circulación colateral y flujo de sangre durante una endarterectomía carotídea. De forma que se puede detectar a tiempo una isquemia severa, y establecer un puente para evitar el riesgo de un “stroke”.

  • El diagnóstico de estenosis y oclusión de arterias intracraneales en pacientes con accidentes cerebro vasculares (CVA) o ataques isquémicos transitorios (TIA).

  • Para la evaluación de pacientes con anemia trepanocítica (“sickle cell disease”) sin síntomas de TIA o CVA, para evaluar el riesgo de un accidente transitorio isquémico (TIA) o un accidente cardiovascular.

    • El Doppler Transcraneal no se considera para pago:
  • En la evaluación de los cambios hemodinámicos de aterosclerosis vascular extracraneal.

  • En el diagnóstico y evaluación de patrones circulatorios de malformaciones arteriovenosas.

  • La evaluación del flujo sanguíneo cerebral como resultado de trauma.

  • La evaluación de la circulación cerebral como una medida de muerte cerebral.

  • En la evaluación de migraña y dolor de cabeza por tensión.

  • En la evaluación del flujo sanguíneo cerebral y posibles eventos embólicos durante el uso de circulación extracorpórea.

  • En la evaluación de patrones de flujo sanguíneo-cerebral en infecciones del sistema nervioso central.

  • La evaluación de demencia.

  • La evaluación de hidrocefalia.

  • La evaluación de glaucoma.

  • Monitoreo de la terapia vasodilatora como tratamiento de desórdenes del comportamiento o del desarrollo incluyendo pero no limitándose a desorden de atención con hiperactividad, autismo, o síndrome de Touerette

    • Códigos
    Number Description
    93886 Transcranial Doppler study of the intracranial arteries; complete study
    93888 ;limited study
    93890 ;vasoreactivity study
    93892 ;emboli detection without intravenous microbubble injection
    93893 ; emboli detection with intravenous microbubble injection

    ICD-9 CM Descripción
    282.6 Sickle-cell disease, unspecified
    282.61 Hb-SS disease without crisis
    282.62 Hb-SS disease with crisis
    282.63 Sickle-cell/Hb-C disease without crisis
    282.64 Sickle-cell/Hb-C disease with crisis
    282.68 Other sickle-cell disease without crisis
    282.69 Other sickle-cell disease with crisis
    342.82 Other specified hemiplegia and hemiparesis affecting nondominant side
    344.9 Paralysis, unspecified
    368.46 Homonymous bilateral field defects
    430 Subarachnoid hemorrhage
    433 Occlusion and stenosis of basilar artery without mention of cerebral infarction
    433.1 Occlusion and stenosis of carotid artery without mention of cerebral infarction
    433.11 Occlusion and stenosis of carotid artery with cerebral infarction
    433.3 Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction
    433.81 Occlusion and stenosis of other specified precerebral artery with cerebral infarction
    434.00 Cerebral thrombosis without mention of cerebral infarction
    434.01 Cerebral thrombosis with cerebral infarction
    434.1 Cerebral embolism without mention of cerebral infarction
    434.11 Cerebral embolism with cerebral infarction
    434.9 Cerebral artery occlusion, unspecified without mention of cerebral infarction
    434.91 Cerebral artery occlusion, unspecified with cerebral infarction
    435 Basilar artery syndrome
    435.1 Vertebral artery syndrome
    435.2 Subclavian steal syndrome
    435.3 Vertebrobasilar artery syndrome
    435.8 Other specified transient cerebral ischemias
    435.9 Unspecified transient cerebral ischemia
    436 Acute, but ill-defined, cerebrovascular disease
    437.0 Cerebral atherosclerosis
    437.1 Other generalized ischemic cerebrovascular disease
    437.2 Hypertensive encephalopathy
    438.85 Other late effects of cerebrovascular disease, vertigo
    447.1 Stricture of artery
    780.2 Syncope and collapse
    781.3 Lack of coordination
    781.4 Transient paralysis of limb
    852 Subarachnoid hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness
    852.01 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness
    852.02 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with brief [less than one hour] loss of consciousness
    852.03 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with moderate [1-24 hours] loss of consciousness
    852.04 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with prolonged [more than 24 hours] loss of consciousness and return to pre-existing conscious level
    852.05 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level
    852.06 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with loss of consciousness of unspecified duration
    852.09 Subarachnoid hemorrhage following injury without mention of open intracranial wound, with concussion, unspecified
    852.1 Subarachnoid hemorrhage following injury with open intracranial wound, unspecified state of consciousness
    852.11 Subarachnoid hemorrhage following injury with open intracranial wound, with no loss of consciousness
    852.12 Subarachnoid hemorrhage following injury with open intracranial wound, with brief [less than one hour] loss of consciousness
    852.13 Subarachnoid hemorrhage following injury with open intracranial wound, with moderate [1-24 hours] loss of consciousness
    852.14 Subarachnoid hemorrhage following injury with open intracranial wound, with prolonged [more than 24 hours) loss of consciousness and return to pre-existing conscious level
    852.15 Subarachnoid hemorrhage following injury with open intracranial wound, with prolonged [more than 24 hours] loss of consciousness without return to pre-existing conscious level
    852.16 Subarachnoid hemorrhage following injury with open intracranial wound, with loss of consciousness of unspecified duration
    852.19 Subarachnoid hemorrhage following injury with open intracranial wound, with concussion, unspecified
    900.89 Injury to other specified blood vessels of head and neck

    ICD-10-CM (effective date 10/01/2015) Descripción
    D57.00 Hb-SS disease with crisis, unspecified
    D57.1 Sickle-cell disease without crisis
    D57.20 Sickle-cell/Hb-C disease without crisis
    D57.219 Sickle-cell/Hb-C disease with crisis, unspecified
    D57.80 Other sickle-cell disorders without crisis
    D57.819 Other sickle-cell disorders with crisis, unspecified
    G45.0 Vertebro-basilar artery syndrome
    G45.1 Carotid artery syndrome (hemispheric)
    G45.8 Other transient cerebral ischemic attacks and related syndromes
    G45.9 Transient cerebral ischemic attack, unspecified
    G81.93 Hemiplegia, unspecified affecting right nondominant side
    G81.94 Hemiplegia, unspecified affecting left nondominant side
    G83.9 Paralytic syndrome, unspecified
    H53.469 Homonymous bilateral field defects, unspecified side
    I60.9 Nontraumatic subarachnoid hemorrhage, unspecified
    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
    I63.231 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
    I63.30 Cerebral infarction due to thrombosis of unspecified cerebral artery
    I63.40 Cerebral infarction due to embolism of unspecified cerebral artery
    I63.50 Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
    I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
    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
    I66.9 Occlusion and stenosis of unspecified cerebral artery
    I67.2 Cerebral atherosclerosis
    I67.4 Hypertensive encephalopathy
    I67.81 Acute cerebrovascular insufficiency or:
    I67.82 Cerebral ischemia
    I67.848 Other cerebrovascular vasospasm and vasoconstriction
    I67.89 Other cerebrovascular disease
    I69.998 Other sequelae following unspecified cerebrovascular disease
    I77.1 Stricture of artery
    R27.0 Ataxia, unspecified
    R27.8 Other lack of coordination
    R27.9 Unspecified lack of coordination
    R29.5 Transient paralysis
    R55 Syncope and collapse
    S01.90XA Unspecified open wound of unspecified part of head, initial encounter
    S01.90XD Unspecified open wound of unspecified part of head, subsequent encounter
    S01.90XS Unspecified open wound of unspecified part of head, sequela
    S06.6X1A Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
    S06.6X1D Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, subsequent encounter
    S06.6X1S Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, sequela
    S06.6X2A Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
    S06.6X2D Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, subsequent encounter
    S06.6X2S Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, sequela
    S06.6X3A Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
    S06.6X3D Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, subsequent encounter
    S06.6X3S Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
    S06.6X4A Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
    S06.6X4D Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, subsequent encounter
    S06.6X4S Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, sequela
    S06.6X5A Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
    S06.6X5D Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, subsequent encounter
    S06.6X5S Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
    S06.6X6A Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
    S06.6X6D Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, subsequent encounter
    S06.6X6S Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
    S06.6X7A Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
    S06.6X7D Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, subsequent encounter
    S06.6X7S Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, sequela
    S06.6X8A Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
    S06.6X8D Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, subsequent encounter
    S06.6X8S Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, sequela
    S06.6X9A Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter
    S06.6X9D Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, subsequent encounter
    S06.6X9S Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, sequela
    S09.0XXA Injury of blood vessels of head, not elsewhere classified, initial encounter
    S09.0XXD Injury of blood vessels of head, not elsewhere classified, subsequent encounter
    S09.0XXS Injury of blood vessels of head, not elsewhere classified, sequela
    S15.8XXA Injury of other specified blood vessels at neck level, initial encounter
    S15.8XXD Injury of other specified blood vessels at neck level, subsequent encounter
    S15.8XXS Injury of other specified blood vessels at neck level, sequela

    ICD-10 CM (effective 10/01/2016) Description
    I63.543 Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries

    ICD-10-CM (Termination date 10/01/2015) Description
    I63.139 Cerebral infarction due to embolism of unspecified carotid artery
    I63.239 Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid arteries
    I65.29 Occlusion and stenosis of unspecified carotid artery
    I66.09 Occlusion and stenosis of unspecified middle cerebral artery
    I66.19 Occlusion and stenosis of unspecified anterior cerebral artery
    I66.29 Occlusion and stenosis of unspecified posterior cerebral artery

    Limitación
    Según establecido en la póliza.
    ___________ ____________________________________
    Ángela Hernández, MD Benjamín Santiago, MD
    Director Médico Asociado VP Manejo Clínico
    Rev. 06/23/2017
    09/19/2016
    05/16/2016
    10/01/13
    10/12/11 (ICD-10 added)
    07/08/10 - Policy archived
    05/13/09(iCES)
    12/02/07
    02/23/05
    09/14/99

    Referencias

  • 1994 TEC Assessment, Tab 20.

  • American Academy of Neurology Therapeutics and Technology Assessment Subcommittee. Assessment: transcranial Doppler. Neurology 1990; 40(4):680-1.

  • Adams RJ, McKie VC, Hsu L et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 1998; 339(1):5-11.

  • Cohen AR. Sickle cell disease—new treatments, new questions. N Engl J Med 1998; 339(1):42-4.

    • A search of the literature was completed through the MEDLINE database for the period of January 1994 through April 1999. The search strategy focused on references containing the following words:
  • Transcranial Doppler

  • Ultrasonography

  • Sickle Cell Anemia

    • See also:
    TEC Assessments Transcranial Doppler Ultrasound 1994: Tab 20