LCD and Article Updates for April 2021
New LCDs/Articles
Colon Capsule Endoscopy (CCE) (L38571)
CCE is a noninvasive procedure that does not require air inflation or sedation and allows for minimally invasive and painless colonic evaluation. It is an alternative procedure to diagnostic colonoscopy or CT colonography. CCE utilizes a tiny wireless camera that takes pictures of the gastrointestinal tract. The provider reviews the video to look for any abnormalities within the gastrointestinal tract. This new LCD will be effective 4/15/2021.
Billing and Coding: Colon Capsule Endoscopy (CCE) (A58294)
This article provides CPT and ICD-10 guidance for billing colon capsule endoscopy.
Revised LCDS/Articles
Facet Joint Interventions for Pain Management (L35936)
The title of the LCD has been revised to: Facet Joint Interventions for Pain Management, and the whole LCD has been revised based on the multijurisdictional CAC meeting that was held on 5/28/2020 via teleconference hosted by: CGS Administrators, First Coast Service Options, National Government Services, Noridian Healthcare Solutions, Palmetto GBA and Wisconsin Physician Service Insurance Corporation.
Billing and Coding: Facet Joint Interventions for Pain Management (A57826)
The title has been changed to Facet Joint Interventions for Pain and the whole article has been revised based on the multijurisdictional CAC meeting that was held on 5/28/2020 via teleconference hosted by: CGS Administrators, First Coast Service Options, National Government Services, Noridian Healthcare Solutions, Palmetto GBA and Wisconsin Physician Service Insurance Corporation.
The article has been updated to add a language change to the KX modifier requirements. The language in the following sentence has been changed to: If the initial diagnostic injections do not produce a positive response as defined by the policy and are not indicative of identification of the pain generator, and it is necessary to perform additional diagnostic injections, at a different level, append the KX modifier to the line.
Heavy Metal Testing (L35074/A56767)
This LCD was returned for comment from 9/24/2020–11/7/2020 for Jurisdictions 6 and K. Coverage Indications, Limitations and/or Medical Necessity was revised to include non-coverage of Zinc testing for the diagnosis of depression.
Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor (L37421)
Based on a Reconsideration Request "Tremor-Dominant Parkison's disease (TDPD) has been added to the Coverage Indications, Limitations and/or Medical Necessity section, along with other changes. Changes have also been made to the Analysis of Evidence section. "Tremor-Dominant Parkinson's disease (TDPD)" has been added to the Summary of Analysis section. Additional sources have been added to the bibliography. The title of the LCD has been revised to remove the word "Essential".
Billing and Coding: Magnetic Resonance Image Guided High Intensity Focused Ultrasound (MRgFUS) for Tremor (A57435)
Based on a Reconsideration Request the diagnosis code G20 was added to the ICD-10 Codes that Support Medical Necessity section. The title of the Billing and Coding Article has been revised to remove the word "Essential".
Select Minimally Invasive GERD Procedures (L35080)
Based on a reconsideration request for the Stretta® procedure, the “Summary of Evidence” and “Analysis of Evidence” sections have been revised and sources have been added to the “Bibliography” section of the LCD. No changes were made in coverage.
Billing and Coding: Hyaluronans Intra-articular Injections of (A52420)
The article has been updated to add Synojoynt™ and Triluron™ to the "Documentation and Utilization" sections of the article and the following language has been added to the Group 1 Paragraph section:
For dates of service on or after 10/1/2019 HCPCS code J7331 should be used to report Synojoynt™.
For dates of service on or after 10/1/2019 HCPCS code J7332 should be used to report Triluron™.
This information was inadvertently removed when the article was converted to the new Billing and Coding format.
Billing and Coding: Molecular Pathology Procedures (A56199)
Added Proprietary Laboratory Analysis (PLA) code 0027U to the coding information section:
CPT Codes 81279 JAK2 (Janus kinase 2) (eg, myeloproliferative disorder), (exon 12 sequence and exon 13 sequence) and 0027U (Janus kinase 2) (e.g., myeloproliferative disorder), gene analysis, targeted sequence analysis exons 12-15 are considered medically necessary in the initial work-up of BCR-ABL and JAK2 (V617F variant) negative adults with clinical, laboratory or pathological findings suggesting polycythemia vera.
Added PLA code 0027U to the ICD-10-CM Diagnosis Codes That Support Medical Necessity section-Group 14.
Billing and Coding: Nivolumab (A54862)
Based on provider comment and compendia review, ICD-10 codes C05.8, C10.0, C10.1, C10.2, C10.4, C10.8, C16.1, C16.2, C16.3, C16.4, C16.5, C16.6, C16.8, C17.3, C24.1, C63.2 and D37.1 have been added effective for dates of service on or after 4/1/2021.
Billing and Coding: Stem Cell Transplantation (A52879)
Based on Transmittal 10566, Change Request 12027 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs) – April 2021, ICD-10 codes D57.03, D57.09, 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 and D57.459, have been added to the Group 1 list effective for dates of service on or after 10/1/2020, ICD-10 procedure codes 30230C0, 30233C0, 30240C0, 30243C0 have been added to the code list for Hematopoietic Progenitor Cell (HPC);Autologous Transplantation effective for dates of service on or after 10/1/2020.
Self-Administered Drug Exclusion List: Medical Policy Article (A53021 JK and A53022 J6)
The article has been updated to add an effective date of 5/15/2021 for J1628 (Guselkumab, Tremfya®).
Posted 3/25/2021