LCD and Article Updates for October 2020
LCD Revisions:
Transcranial Magnetic Stimulation (L33398)
The notice period was extended to end on 9/30/2020 and the Revision Effective date has been changed from 8/1/2020 to 10/1/2020.
Billing and Coding Article Updates:
Billing and Coding: Bevacizumab and biosimilars (A52370)
Based on the annual ICD-10 code update, ICD-10 code G96.8 has been deleted in Group 1 and replaced with G96.89.
Billing and Coding: Cardiac Catheterization and Coronary Angiography (A52850)
Based on the annual ICD-10 updates for 2021, ICD-10 code G11.1 was deleted and is replaced by G11.11 in Groups 1 and 2 covered diagnoses. In addition, to clarify coding, the ICD-10 section has been revised to remove the requirement for multiple ICD-10 groups for specified CPT codes, and Group 3 has been revised to remove CPT codes 93458, 93459, 93460 and 93461.
Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses (A57026)
Due to the annual ICD-10 updates, K59.8 has been deleted, and new codes K59.81 and K59.89 have been added effective 10/01/2020.
Billing and Coding: Corneal Pachymetry (A56548)
Due to the annual ICD-10-CM update, ICD-10-CM code, H18.51, was deleted from the “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes H18.511, H18.512, H18.513 – Group 1.
ICD-10-CM codes, H18.501; H18.502, H18.503, H18.521, H18.522, H18.523, H18.531, H18.532, H18.533, H18.541, H18,542, H18.543, H18.551, H18.552, H18.553, H18.591, H18.592, H18.593, T86.8481, T86.8482, T86.8483, T86. 8491, T86.8492, T86.8493 were added to the “ICD-10-CM Codes That Support Medical Necessity” section - Group 1
ICD-10-CM code H18.59, was deleted - Group 1
ICD-10-CM code T86.840 was deleted from the “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes T86.8401, T86.8402, T86.8403 – Group 1
ICD-10-CM code T86.841 was deleted from the “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes T86.8411, T86.8412, T86.8413– Group 1
Billing and Coding: Denosumab (Prolia ™, Xgeva ™)(A52399)
Based on the annual ICD-10 code update, the following ICD-10 codes (M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP and M80.0AXS) have been added to ICD-10 code range M80.00XA - M80.88XS in Groups 2, 3, 5 and 8. The following ICD-10 codes (M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP and M80.8AXS) have been added to Groups 2, 3, 5 and 8. In Group 4, ICD-10 code N18.3 has been deleted and replaced with N18.30, N18.31 and N18.32. The descriptor for ICD-10 code Z88.8 was changed in Group 4.
Billing and Coding: EEG – Ambulatory Monitoring (A57030)
Due to annual ICD-10 updates, the following codes have been added to Group 1 in the ICD-10 Codes that Support Medical Necessity section: G40.42, G40.833, G40.834.
Billing and Coding: Heavy Metal Testing (A56767)
Based on the annual ICD-10 updates for 2021, G11.1 was deleted from ICD-10 Codes that Support Medical Necessity, Group 13 and replaced by G11.10, G11.12, and G11.19. N18.3 was deleted from ICD-10 Codes that Support Medical Necessity, Group 1 and replaced by N18.30, N18.31, and N18.32.
Billing and Coding: Hypoglossal Nerve Stimulation for Treatment of Obstructive Sleep Apnea (A57092)
Based on the annual ICD-10 code update, the descriptor has changed for ICD-10 codes Z68.1, Z68.20, Z68.21, Z68.22, Z68.23, Z68.24, Z68.25, Z68.26, Z68.27, Z68.28, Z68.29, Z68.30, Z68.31, Z68.32, Z68.33 and Z68.34 in Group 2.
Billing and Coding: Ibandronate Sodium (A52421)
Based on the annual ICD-10 code update, ICD-10 codes M80.0AXA, M80.0AXD, M80.0AXG, M80.0AXK, M80.0AXP and M80.0AXS have been added to code range M80.00XA - M80.88XS and ICD-10 codes M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP and M80.8AXS have been added to Group 2. ICD-10 codes K20.8 and K20.9 have been deleted and replaced by K20.80, K20.81, K20.90 and K20.91 in Coding Information Guideline 1 and Group 3 in the ICD-10 Codes that Support Medical Necessity section.
Billing and Coding: Infliximab and biosimilars (A52423)
Based on the annual ICD-10 update, ICD-10 codes M05.7A and M05.8A have been added to ICD-10 code range M05.00-M05.9, ICD-10 code M06.0A has been added to ICD-10 code range M06.00-M06.39, ICD-10 code M06.8A has been added to ICD-10 code range M06.80-M06.9, ICD-10 code M08.0A has been added to ICD-10 code range M08.00-M08.29 and ICD-10 codes M08.2A and M08.9A have been added in Group 2.
Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)
Based on the annual ICD-10 code update, ICD-10 code D59.1 has been deleted and replaced with D59.11, D59.12, D59.13 and D59.19.
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56747)
Based on the annual ICD-10 update for 2021, ICD-10 code N18.3 has been deleted and replaced by N18.30, N18.31 and N18.32 in Groups 3 and 4 covered diagnoses. The descriptor for code Z88.8 has been revised in Group 4 covered diagnoses.
Billing and Coding: Nerve Conduction Studies and Electromyography (A57668)
Based on the annual ICD-10 updates for 2021, ICD-10 codes G11.1 and G71.2 were deleted and replaced by G11.10, G11.12, G11.19, G71.20, G71.21, G71.220, G71.228, and G71.29 in Group 1 covered diagnoses.
Billing and Coding: Nivolumab (A54862)
Based on FDA and Compendia review, ICD-10-CM codes C15.3, C15.4, C15.5, C15.8, C16.0, D37.8, Z85.01 have been added effective for dates of service on or after 6/10/2020.
Billing and Coding: Non-Invasive Vascular Studies (A56758)
Based on the annual ICD-10 updates for 2021, K74.0 and R74.0 were deleted from ICD-10 Codes that Support Medical Necessity, Group 5 and replaced by K74.00, K74.01, K74.02, R74.01 and R74.02.
N18.3 was deleted from ICD-10 Codes that Support Medical Necessity, Group 6 and replaced by N18.30, N18.31, and N18.32.
The following codes were added to ICD-10 Codes that Support Medical Necessity, Group 2: D57.03, D57.09, 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 and D57.459.
D57.411 and D57.412 descriptors were changed in ICD-10 Codes that Support Medical Necessity, Group 2.
Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) (A56726)
Due to the annual ICD-10-CM update, ICD-10-CM codes H55.81, H55.82, D57.03, D57.09, D57.213, D57.218, D57.813, and D57.818 were added to Group 3- "ICD-10-CM Codes That Support Medical Necessity" section.
ICD-10-CM code E70.8 was deleted from Group 3.
Billing and Coding: Outpatient Physical and Occupational Therapy Services (A56566)
Based on the annual ICD-10 updates for 2021, ICD-10 code J82 has been deleted and replaced by J82.81, J82.82, J82.83 and J82.89 in the list of non-covered diagnoses for CPT code 97035.
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (A52450)
Based on compendia review, ICD-10-CM code C22.3 has been added to Group 2 for paclitaxel effective for dates of service on or after 10/01/2020.
Billing and Coding: Peripheral Nerve Blocks (A57452)
Due to the annual ICD-10 updates, ICD-10 code R51 has been deleted from Group 1 and Group 2 in the ICD-10 Codes that Support Medical Necessity section and new ICD-10 code R51.9 has been added.
In Group 2 under the “CPT/HCPCS Codes” section “Non-Covered” has been removed. The following language has also been removed from Group 2 and added to the “Article Text” section: “ "Dry needling" of ganglion cysts, ligaments, neuromas, peripheral nerves, tendon sheaths and their origins/insertions, or any tissue are non-covered procedures.” The following statement has been added to the Group 2 Paragraph under the “CPT/HCPCS Codes” section and the Article Text: "Effective January 21, 2020, all types of acupuncture including dry needling for any condition other than chronic low back pain are non-covered by Medicare. Medicare will cover acupuncture for Medicare patients with chronic lower back pain within specific guidelines in accordance with NCD 30.3.3."
The Group 1 Paragraph under the ICD-10 Codes that Support Medical Necessity was corrected to remove the following codes: 64402 and 64413.
Billing and Coding: Psychiatric Inpatient Hospitalization (A56865)
Based on the annual ICD-10 updates for 2021, the following codes were added to ICD-10 Codes that Support Medical Necessity, Group 1: F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131 and F19.132.
Billing and Coding: Psychiatric Partial Hospitalization Programs (A56850)
Based on the annual ICD-10 updates for 2021, the following codes were added to ICD-10 Codes that Support Medical Necessity, Group 1: F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131 and F19.132.
Billing and Coding: Psychiatry and Psychology Services (A56937)
Based on the annual ICD-10 updates for 2021, the following codes were added to ICD-10 Codes that Support Medical Necessity, Group 1: F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131 and F19.132.
Billing and Coding: RAST Type Tests (A56844)
Based on the annual ICD-10 updates for 2021, T40.4X5A, T40.4X5D and T40.4X5S were deleted from ICD-10 Codes that Support Medical Necessity and replaced by T40.495A, T40.495D and T40.495S.
Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™) (A52452)
Based on the annual ICD-10 code update, ICD-10 code D59.1 has been deleted and replaced with ICD-10 codes D59.11, D59.12, D59.13 and D59.19. Code range M05.00 - M05.9 has been broken out to not include new ICD-10 codes M05.7A and M05.8A, code range M06.00 - M06.39 has been broken out to not include new ICD-10 code M06.0A and code range M06.80 - M06.9 has been broken out to not include new ICD-10 code M06.8A.
Billing and Coding: Routine Foot Care and Debridement of Nails (A57759)
Based on annual ICD-10 updates for 2021, ICD-10 codes G11.1 and N18.3 were deleted and replaced by G11.10, G11.11, G11.19 for Groups 1 and 4, and N18.30, N18.31 and N18.32 for Group 1 covered diagnoses.
Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (A56537)
Due to the annual ICD-10-CM update, the following ICD-10-CM codes M06.0A and M06.8A were added to code range M06.00 - M06.9- Group 3 (CPT code 92134) and M06.0A was added to Group1(CPT code 92132).
ICD-10-CM code H18.50 was deleted from “ICD-10-CM Codes That Support Medical Necessity” section and replaced by H18.501; H18.502, H18.503, and H18.51 was deleted and replaced by ICD-10-CM codes H18.511, H18.512, H18.513 – Group 1 (CPT code 92132)
ICD-10-CM code T86.840 was deleted from “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes T86.8401, T86.8402, T86.8403 – Group 1 (CPT code 92132)
ICD-10-CM code T86.841 was deleted from “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes T86.8411, T86.8412, T86.8413– Group 1 (CPT code 92132)
ICD-10-CM code T86.842 was deleted from “ICD-10-CM Codes That Support Medical Necessity” section and replaced by ICD-10-CM codes T86.8421, T86.8422, T86.8423– Group 1 (CPT code 92132)
ICD-10-CM code Z03.823 was added to Group 4.
ICD-10-CM codes, H18.521, H18.522, H18.523, H18.531, H18.532, H18.533, H18.541, H18,542, H18.543, H18.551, H18.552, H18.553, H18.591, H18.592, H18.593, T86.8481, T86.8482, T86.8483, T86.8491, T86.8492, T86.8493 were added to the “ICD-10-CM Codes That Support Medical Necessity” section – Group 1 (CPT code 92132).
Billing and Coding: Select Minimally Invasive GERD Procedures (A56863)
Based on the annual ICD-10 code update, ICD-10-CM code K21.0 has been deleted and replaced with K21.00.
Billing and Coding: Stem Cell Transplantation (A52879)
Based on the annual ICD-10 code update, the descriptor for ICD-10 codes D57.411, D57.412 and D57.419 has been changed in Group 1.
Billing and Coding: Urine Drug Testing (A56761)
Based on the annual ICD-10 updates for 2021, T40.4X1A, T40.4X2A, T40.4X3A and T40.4X4A were deleted from ICD-10 Codes that Support Medical Necessity and replaced by T40.491A, T40.492A, T40.493A and T40.494A.
Billing and Coding: Visual Fields Testing (A56551)
Due to the annual ICD-10-CM update, diagnosis codes G40.42, M05.8A, and H55.82 were added to the "ICD-10-CM Codes That Support Medical Necessity" section- Group1- (CPT codes 92081, 92082, and 92083)
ICD-10-CM code H55.81 descriptor was changed in Group 1
Billing and Coding: Vitamin D Assay Testing (A57736)
Based on the annual ICD-10 code update the following changes have been made in Group 1: ICD-10-CM codes M80.0AXA, M80.0AXD, M80.0ASG, M80.0AXK, M80.0AXK and M80.0AXS have been added to code range M80.00XA - M80.88XS and ICD-10-CM codes M80.8AXA, M80.8AXD, M80.8AXG, M80.8AXK, M80.8AXP and M80.8AXS have been added. ICD-10-CM code N18.3 has been deleted and replaced with N18.30, N18.31 and N18.32. The description for ICD-10-CM codes Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44 and Z68.45 has been changed.
Health and Behavior Assessment/Intervention – Medical Policy Article (A52434)
Based on the annual ICD-10 updates for 2021, the following codes were added to ICD-10 Codes that DO NOT Support Medical Necessity, Group 1: F10.130, F10.131, F10.132, F10.139, F10.930, F10.931, F10.932, F10.939, F11.13, F12.13, F13.130, F13.131, F13.132, F13.139, F14.13, F14.93, F15.13, F19.130, F19.131, F19.132 and F19.139.
Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article (A52447)
Based on the annual ICD-10 updates for 2021, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44 and Z68.45 descriptors were changed in ICD-10 Codes that Support Medical Necessity, Group 2.
Posted 9/29/2020