Local Coverage Determination and Article Revisions September‒October 2019
All medical policies and related articles can be found on the NGS Medical Policy Center.
Bevacizumab and Biosimilars - Related to LCD L33394 (A52370)
Bevacizumab-awwb and HCPCS code Q5107 have been added to the CPT/HCPCS code section and throughout the article effective for dates of service on or after 07/18/2019. Based on Transmittal 4367 (CR 11422 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2019 Update), HCPCS code Q5118 for bevacizumab-bvzr has been added to the CPT/HCPCS paragraph code section and throughout the article effective for dates of service on or after 10/1/2019. Based on compendia review, ICD-10-CM code C45.1 has been added to the Group 1 code list effective for dates of service on or after 10/1/2019.
Billing and Coding: Cardiac Catheterization and Coronary Angiography (A52850)
ICD-10 codes I70.238 and I70.248 have been revised.
Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (A56737)
Deleted ICD-10 codes I48.1 and I48.2 were replaced by codes I48.11, I48.19, I48.20 and I48.21 in Group 1.
Billing and Coding: Cardiovascular Nuclear Medicine (A56743)
Article revised for annual ICD-10 updates for 2020. ICD-10 codes I48.11, I48.19, I48.20 and I48.21 replaced deleted codes I48.1 and I48.2 in Group 1.
Billing and Coding: Frequency of Hemodialysis (A55672)
Article revised in response to an inquiry to add clarification to the approaches for billing hemodialysis sessions. Additionally, due to system changes in response to CMS Change Request 10901, this article has undergone some reorganization in the coding section and the following new fields have been added: CPT/HCPCS Modifier, Additional ICD-10 Information, and Other Coding Information.
Billing and Coding: Magnetic Resonance Angiography (MRA) (A56747)
Due to the annual ICD-10 update for 2020, deleted ICD-10 codes H81.41, H81.42 and H81.43 were replaced by code H81.4 in Group 1.
Billing and Coding: Non-Invasive Vascular Studies (A56758)
Article revised for annual ICD-10-CM update for 2020, I80.241, I80.242, I80.243, I80.251, I80.252 and I80.253 were added to ICD-10 Codes that Support Medical Necessity in Group 4.
ICD-10 codes I70.238 and I70.248 were revised in Codes that Support Medical Necessity Groups 3 and 8.
Billing and Coding: Nonvascular Extremity Ultrasound (A56787)
Article revised due to the annual ICD-10-CM code update, the descriptors were changed for ICD-10-CM codes M66.88, M77.51 and M77.52. This article was converted to the new Billing and Coding Article type. Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.
Billing and Coding: Pain Management (A52863)
The article has been revised for annual ICD-10-CM code updates. The descriptor for ICD-10-CM codes M77.51 and M77.52 was changed in Group 2. Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections. This article was converted to the new Billing and Coding Article type.
Billing and Coding: Transesophageal Echocardiography (TEE) (A52868)
Article revised for annual ICD-10 updates for 2020. ICD-10 codes I48.11, I48.19, I48.20 and I48.21 have replaced deleted codes I48.1 and I48.2 in Groups 1 and 3.
Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)
Article revised for annual ICD-10 updates for 2020. ICD-10 codes I48.11, I48.19, I48.20 and I48.21 have replaced deleted codes I48.1 and I48.2 in Group 1.
Reference to CPT code 75571 was deleted.
Billing and Coding: Urine Drug Testing (A56761)
Article revised due to the annual ICD-10-CM update for 2020, T50.911A, T50.911D, T50.911S, T50.912A, T50.912D, T50.912S, T50.913A, T50.913D, T50.913S, T50.914A, T50.914D, T50.914S, T50.915A, T50.915D, T50.915S, T50.916A, T50.916D, T50.916S were added to the ICD-10 Codes that Support Medical Necessity section in Group 1.
Breast Imaging: Breast Echography (Sonography)/Breast MRI/Ductography (L33585)
LCD revised due to the annual ICD-10-CM update. N63.15 and N63.25 were added to the ICD-10 Codes that Support Medical Necessity section in Group 1.
Eculizumab (Soliris®) - Related to LCD L33394 (A54548)
An indication for neuromyelitis optica spectrum disorder (NMOSD) has been added based on FDA approval. ICD-10-CM code G36.0 has been added to the “ICD-10 Codes that are Covered” section effective for dates of service on or after 06/27/2019.
Heavy Metal Testing (L35074)
LCD revised due to the annual ICD-10-CM update for 2020, R11.15 was added to the ICD-10 Codes that Support Medical Necessity section in Group 3.
Hyaluronans Intra-articular Injections of - Related to LCD L33394 (A52420)
Based on Transmittal 4367 (CR 11422 - Quarterly Healthcare Common Procedure Coding System (HCPCS) Drug/Biological Code Changes - October 2019 Update), HCPC codes J7331 has been added for Synojoynt™ and J7332 has been added for Triluron™ to the CPT/HCPC paragraph section of the article. Synojoynt™ and Triluron™ have been added throughout the article.
Implantable Automatic Defibrillators – Coding and Billing (A56326)
Based on Transmittal 4324 (CR 11333 - Fiscal Year (FY) 2020 Annual Update to the Medicare Code Editor (MCE) and International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS), ICD-10-PCS codes 0JH60FZ, 0JH63FZ, 0JPT0FZ and 0JPT3FZ have been added to item “D. Other” section of the article effective for dates of service on or after 10/01/2019.
Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article (A52447)
Article revised due to the annual ICD-10-CM update for 2020, Z68.43 description was changed in the Covered ICD-10 Codes section in Group 2.
Outpatient Physical and Occupational Therapy Services (L33631)
LCD revised for annual ICD-10 update for 2020. ICD-10 codes L89.006, L89.016, L89.026, L89.106, L89.116, L89.126, L89.136, L89.146, L89.156, L89.206, L89.216, L89.226, L89.306, L89.316, L89.326, L89.46, L89.506, L89.516, L89.526, L89.606, L89.616, L89.626, L89.816, L89.896 and L89.96 were added to the list of non-covered diagnoses for CPT 97035.
Routine Foot Care and Debridement of Nails (L33636)
LCD revised for annual ICD-10 update for 2020. ICD-10 codes I80.241, I80.242, I80.243, I80.251, I80.252 and I80.253 were added to Group 1, ICD-10 Codes that Support Medical Necessity.
Single Chamber and Dual Chamber Permanent Cardiac Pacemakers – Coding and Billing (A54909)
Based on annual ICD-10 updates, ICD-10-CM code I48.1 has been deleted and replaced with I48.11 and I48.19 effective for dates of service on or after 10/01/2019. All reference to ICD-9-CM codes has been removed.
Stem Cell Transplantation – Medical Policy Article (A52879)
Based on Transmittal 2348, Change Request 11392 - International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determination (NCDs): ICD-10 PCS codes 30250G1, 30250Y1, 30253G1, 30253Y1, 30260G1, 30260Y1, 30263G1, 30263Y1, 30250G0, 30250Y0, 30253G0, 30253Y0, 30260G0, 30260Y0, 30263G0 and 30263Y0 have been deleted effective 09/30/2019.
Urodynamics (L33576)
LCD revised due to the annual ICD-10-CM code update, the descriptor was changed for ICD-10-CM code N35.814.
Vitamin D Assay Testing (L37535)
LCD revised for annual ICD-10-CM code updates. The descriptor for ICD-10-CM code Z68.43 was changed in Group 1.
LCDs Converted to “No Codes” Format
The following LCDs were converted to the new “no codes” format. There have been no changes in coverage with these revisions:
L36236 ‒ Autonomic Function Testing
L33557 ‒ Cardiac Catheterization and Coronary Angiography
L33559 ‒ Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
L33560 ‒ Cardiovascular Nuclear Medicine
L33558 ‒ Cataract Extraction
L33392 ‒ Category III CPT® Codes
L33562 ‒ Computed Tomographic (CT) Colonography for Diagnostic Uses
L38014 ‒ Corneal Hysteresis
L33630 ‒ Corneal Pachymetry
L33399 ‒ EEG – 24 Hour Monitoring
L37475 ‒ Frequency of Hemodialysis
L37606 ‒ Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases
L37810 ‒ Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms
L33563 ‒ Incision and Drainage (I & D) of Abscess of Skin, Subcutaneous and Accessory Structures
L33633 ‒ Magnetic Resonance Angiography (MRA)
L35000 ‒ Molecular Pathology Procedures
L33627 ‒ Non-Invasive Vascular Studies
L33619 ‒ Nonvascular Extremity Ultrasound
L33621 ‒ Ophthalmic Biometry for Intraocular Lens Power Calculation
L33567 ‒ Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
L33622 ‒ Pain Management
L33628 ‒ Panretinal (Scatter) Laser Photocoagulation
L37485 ‒ Prostate Rectal Spacers
L34380 ‒ Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
L33579 ‒ Transesophageal Echocardiography (TEE)
L33577 ‒ Transthoracic Echocardiography (TTE)
L36037 ‒ Urine Drug Testing
L33574 ‒ Visual Fields Testing
Articles Converted to New Coding Format
These articles were revised to convert to the new coding format and to remove bill types and revenue codes:
A56544 ‒ Billing and Coding: Cataract Extraction
A56195 ‒ Billing and Coding: Category III CPT® Codes
A56248 ‒ Billing and Coding: Corneal Hysteresis
A56548 ‒ Billing and Coding: Corneal Pachymetry
A56766 ‒ Billing and Coding: Incision and Drainage (I&D) of Abscess of Skin, Subcutaneous and Accessory Structures
A56199 ‒ Billing and Coding: Molecular Pathology Procedures
A56549 ‒ Billing and Coding: Ophthalmic Biometry for Intraocular Lens Power Calculation
A56726 ‒ Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography)
A56550 ‒ Billing and Coding: Panretinal (Scatter) Laser Photocoagulation
A56539 ‒ Billing and Coding: Prostate Rectal Spacers (will be published 10/3/2019)
A56537 ‒ Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
A56551 ‒ Billing and Coding: Visual Fields Testing
New Billing and Coding Articles
A57024 – Billing and Coding: Autonomic Function Testing
A57026 – Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses
A57030 – Billing and Coding: EEG – 24 Hour Monitoring
Posted 9/27/2019