Health practitioners have to give urgent medical attention if a patient arrives at the hospital with a suspected stroke. The patient has to undergo a number of tests to confirm the diagnosis and risk factors of the stroke. The healthcare provider has to give utmost care to achieve complete and accurate documentation, code assignment, and reporting of diagnosis and treatment procedures. Neurology medical billing outsourcing is a practical way to ensure that the medical billing process is up-to-date and free of error.

The results of stroke are devastating, sometimes resulting in physical, cognitive and mental disabilities. Rapid and accurate diagnosis is essential for providing immediate patient care.

The three main types of strokes are:

  • Ischemic stroke
  • Hemorrhagic stroke
  • Transient ischemic attack

Required diagnostic tests to be reported on the medical claims may include: 

  • Physical examination
  • The blood pressure and heartbeat are analyzed to determine the cause of the stroke. A neurological examination is also conducted to know how the stroke is affecting the nervous system.

  • Blood tests
  • Profiling of blood is carried out to know the level of cholesterol and glucose levels in the blood. Tests are also done to assess how fast the blood clots.

  • Computerized Tomography Scan ( CT Scan)
  • The patient has to undergo neuroimaging within one hour of getting admitted to the hospital. In a CT scan, a series of X-rays are used to have a detailed image of the brain. It can show if any bleeding is present due to the brain stroke, tumour or any such conditions.

  • Magnetic Resonance Imaging ( MRI)
  • It can detect brain tissue damage accompanying ischemic stroke and brain haemorrhages with the help of detailed imaging of the brain.

  • Carotid Ultrasound
  • Detailed images of the inside of the carotid arteries in the neck are created with the help of sound waves. This test is done to detect the presence of buildup of fatty deposits and blood flow in the carotid arteries.

  • Echocardiogram
  • It is a live-imaging test done to monitor heart activity. Detailed images of the heart are taken with the help of sound waves to find the source of clots that might have travelled to the brain.

Applicable CPT codes

  • 99291
  • Critical care services include the treatment of vital organ failure or prevention of further life-threatening conditions. Presence of a patient in an ICU or use of ventilation is not sufficient to bill a CC service. The following three criteria must be met for reporting CC service:

  • The severity of illness, the intensity of services required to treat the illness, and the time spent in providing the care.
  • Proper documentation showing the medical necessity for providing CC services is an absolute requirement.
  • Usually, a critical care service is provided to a patient in a “critical care area” such as the coronary care unit (CCU), intensive care unit (ICU), respiratory care unit, or emergency room.

This code is applicable for a critical care service provided for the first 30-74 minutes. Any CC service provided for less than 30 minutes should be billed with the appropriate level of E/M code.
Blood tests

  • 80061

The lab analyst performs a lipid panel test in which she measures the blood level of cholesterol and fats called triglycerides in the blood.

  • 82465
  • The lab analyst measures the level of total cholesterol in a patient specimen of serum or whole blood.

  • 83718
  • The lab analyst performs a test to directly measure the high-density lipoprotein, HDL cholesterol in a patient specimen.

  • 82947
  • The lab analyst performs a test to measure the amount of glucose in a patient’s blood using a method other than a reagent strip.

  • 82948
  • The clinician performs a test to measure the amount of glucose in a patient’s blood using a reagent strip test method.

 CT scan

  • 70450
  • The provider performs computed tomography, or CT scanning, of the head or brain, without contrast. He performs the procedure to diagnose any brain or intracranial abnormalities.

  • 70460
  • The provider performs computed tomography, or CT scanning, of the head or brain, with contrast. He performs the procedure to diagnose any brain or intracranial abnormalities, such as a cerebral aneurysm.

  • 70470
  • The provider performs computed tomography, or CT scanning, of the head or brain, first without and then with contrast and additional images. He performs the procedure to diagnose any brain or intracranial abnormalities, such as a cerebral aneurysm.

MRI Scan

  • 70553
  • In this procedure, the provider performs magnetic resonance imaging, or MRI, the study of the brain including the brain stem. He performs this procedure without using contrast material. He then follows with contrast material and takes more images.

Carotid ultrasound

  • 93880
  • Duplex scanning of arteries for the evaluation of blood flow is a type of non-invasive vascular diagnostic process. A physician can visualize and selectively assess the flow patterns of peripheral vessels using real-time ultrasound imaging and pulsed Doppler. The presence of arterial stenosis, occlusion, and identification of incompetent veins can also be achieved through this process.

Echocardiogram

  • 93308
  • The provider performs a limited or follow-up transthoracic echocardiography to obtain a two dimensional (2D) image of the heart through the chest wall. It is a limited examination of a focused clinical concern that does not attempt to evaluate or document all the heart structures included in a complete echo. This service has both a professional and a technical component.

ICD-10 Diagnosis codes

  • I60 : Nontraumatic subarachnoid haemorrhage
    160.1: Nontraumatic subarachnoid haemorrhage from the middle cerebral artery.

    160.2: Nontraumatic subarachnoid haemorrhage from the anterior communicating artery.

    160.3: Nontraumatic subarachnoid haemorrhage from the posterior communicating artery.

    160.4: Nontraumatic subarachnoid haemorrhage from the basilar artery.

    160.5: Nontraumatic subarachnoid haemorrhage from vertebral artery.

  • I63: Cerebral infarction
    163.0: Cerebral infarction due to thrombosis of precerebral arteries.

    163.1: Cerebral infarction due to embolism of precerebral arteries.

    163.2: Cerebral infarction due to unspecified occlusion or stenosis of precerebral arteries.

    163.3: Cerebral infarction due to thrombosis of cerebral arteries.

    163.4: Cerebral infarction due to embolism of cerebral arteries.

    163.5: Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries.

  • I65: Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction.
    165.0: Occlusion and stenosis of the vertebral artery.

    165.1: Occlusion and stenosis of the basilar artery

    165.2: Occlusion and stenosis of the carotid artery.

  • I66: Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction.
    166.0: Occlusion and stenosis of a middle cerebral artery.

    166.1: Occlusion and stenosis of an anterior cerebral artery.

  • I67: Other cerebrovascular diseases
  • I68: Cerebrovascular disorders in diseases classified elsewhere.
  • I69: Sequelae of cerebrovascular disease

Brain stroke is a medical emergency and it is vital to provide excellent patient care in such demanding circumstances. A neurology medical billing company can assist with timely, accurate and complete documentation of the diagnosis and procedures.