MIR-2006-10A, October 2006

LCD and Article Revisions for October 2006

Audiologic/Vestibular Function Tests – L541
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 7, 8, and 9:

7. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification
   (ICD-9-CM).
8. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
9. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.
Under the “ICD-9-CM Codes That Support Medical Necessity” section, for the CPT codes 92585 and 92586, replaced the deleted code 333.7 with the following codes:

333.71 Athetoid cerebral palsy
333.72 Acute dystonia due to drugs
333.79 Other acquired torsion dystonia

Also, the following ICD-9-CM code descriptors have been updated: 333.6, 389.11, 389.12, 389.14, and 389.18.

Under the “ICD-9-CM Codes That Do Not Support Medical Necessity” section, replaced the deleted code V72.1 with the following codes:

V72.11 Encounter for hearing examination following failed hearing screening
V72.12 Other examination of ears and hearing

Article Revisions:
Under the “Coding Guidelines” section, added number 22:

22. The ICD-9-CM codes 333.7 and V72.1 have been terminated effective September 30, 2006 and the replacement codes 333.71, 333.72, 333.79, V72.11, and V72.12 are effective for services performed on or after October 1, 2006.

Brachytherapy – L447
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 4, 5, 6, and 7:

4. CMS Manual , Publication 100-4, Chapter 13, section 70.2. This section refers to services bundled into treatment management codes.
5. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modifi-cation (ICD-9-CM).
6. Change Request (CR) 5244, dated September 1, 2006. October 2006 Out-patient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
7. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.

Under the “Limitations” section, updated numbers 3 and 4 from:

3. Only a radiologist/radiation oncologist may bill for CPT procedure codes 77790 and 79900.
4. An expendable source (79900) is not separately payable with remote, after loading, high-intensity brachytherapy procedures (77781-77784). The expendable source is included in the cost of the procedure.

To show the following:

3. Only a radiation oncologist/therapeutic radiologist may bill for CPT procedure codes 77790 and Q3001.
4. An expendable source (Q3001) is not separately payable with remote, after-loading, high-intensity brachytherapy procedures (77781-77784). The expendable source is included in the cost of the procedure.

Under the “CPT/HCPCS Codes” section, removed the terminated CPT code 79900 and added the HCPCS code Q3001. Also, removed the following CPT codes:

76950, 77305, 77310, 77315, 77321, 77331 – 77334, 77336, 77370, 77399, 77401 – 77403, 77406 – 77409, 77411 – 77414, 77416 – 77417, 77470, 77600, 77605, 77610, 77615, 77620, and 7779 9

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, added the following ICD-9-CM codes:

372.40 – 372.45, V10.00 – V10.89

Also added a new section of ICD-9-CM codes for the CPT codes 19296 – 19298:

174.0 – 174.9, 175.0, 175.9, 198.81, and V10.3

These sections were updated to coordinate with Empire Medicare Services – Part B.

The deleted code 238.7 has been replaced with the following codes:

Article Revisions:
Under the “Coding Guidelines” section, removed number 9:

9. Do not report x-rays used in brachytherapy simulation with CPT procedure code 77417.

Renumbered 10 – 13 to show as 9 – 12. Updated number 11 from:

11. Under OPPS, HCPCS codes are available for some brachytherapy “pass through” items. CMS issues PMs which specify the codes that can be used. It is strongly recommended that providers review these PMs regularly for the most current update.

To show the following:

11. Many of the CPT codes in the radiation oncology section can be used for both external beam radiation therapy (EBRT) and brachytherapy, while others are specific to one modality or the other. All the CPT codes listed in the “CPT/HCPCS Codes” section, with the exception of 77280, 77285, 77290, 77295, 77300, 77336, 77413, 77417, and 79900, are those specific only to brachytherapy.

Also under this section, added numbers 13 – 19:

13. The following CPT/HCPCS codes are paid under a fee schedule or payment system other than the Outpatient Prospective Payment System (OPPS): 77261, 77262, 77263, and Q3001.
14. Payment for the CPT codes 76001 and 77790 is packaged into payment for other services; therefore, there is no separate APC payment.
15. The CPT code 77900 was terminated December 31, 2004.
16. The HCPCS code Q3001 is effective for services performed on or after January 1, 2005 .
17. The following CPT codes were removed from this LCD to coordinate with Empire Part B: 76950, 77305, 77310, 77315, 77321, 77331 - 77334, 77336, 77370, 77399, 77401 - 77403, 77406 - 77409, 77411 - 77414, 77416 - 77417, 77470, 77600, 77605, 77610, 77615, 77620, and 77799.
18. The CPT codes 55862 and 55865 can be billed on inpatient claims (TOB 12x) only. 
19. The ICD-9-CM code 283.7 was terminated effective September 30, 2006 and the replacement codes 283.71 - 283.76 and 283.79 are effective for services performed on or after October 1, 2006.

Darbepoetin Alfa (Aranesp) for Non-ESRD Use – L13711
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 16, 17, and 18:

16. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification
    (ICD-9-CM).
17. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpa-tient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifi-cations Version 7.3.
18. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, added number 5:

5. List the appropriate anemia diagnosis as the primary diagnosis and the etiology of the anemia as the secondary diagnosis.

Also under this section, the deleted ICD-9-CM code 238.7 has been replaced with the following codes:

Article Revisions:
Under the “Coding Guidelines” section, added number 8:

8. The ICD-9-CM code 238.7 has been terminated effective September 30, 2006, and the replacement codes 238.71 - 238.76 are effective for services performed on or after October 1, 2006.

Erythropoietin (EPO) for Non-ESRD Use – L13701
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 16, 17, 18, 19, and 20:

16. Change Request (CR) 4236, dated December 16, 2005. January 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications.
17. Change Request (CR) 4238, dated December 16, 2005. January 2006 Outpatient Prospective Payment System Outpatient Code Editor (OPPS OCE) Specifications.
18. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification
    (ICD-9-CM).
19. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3. 
20. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

 This section was also updated in the related article.

6. Under the “Indications” section, Special Conditions added number 6: Patients with anemia who are scheduled to undergo either a total knee replacement or total hip replacement must meet all of the following indications:

1. A hgb level between 10 and 13 mg/dl; and
2. Scheduled to undergo either a total knee replacement or total hip replacement and are at risk for peri-operative transfusions due to significant, anticipated blood loss.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, removed the following information:

One ICD-9-CM diagnosis code from each category must be included on the claim for Medicare coverage.

Category I:

Category II:

Also, under this section, added number 5:

5. List the appropriate anemia diagnosis code as the primary diagnosis and the etiology of the anemia as the secondary diagnosis.

The deleted code 238.7 has been replaced with the following codes:

Article Revisions:
Under the “Coding Guidelines” section, added number 7:

7. The ICD-9-CM code 238.7 is terminated effective September 30, 2006, and the replacement codes 238.71 - 238.76 and 238.79 are effective for services performed on or after October 1, 2006. 

Neupogen, Filgrastim – L529
Under the “CMS National Coverage Policy” section, added numbers 8, 9, and 10:

8. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification
   (ICD-9-CM).
9. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
10. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifi-cations Version 22.0.

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, the deleted code 288.0 has been replaced with the following codes:

Article Revisions:
Under the “Coding Guidelines” section added number 11:

11. The ICD-9-CM code 288.0 was deleted effective September 30, 2006, and the replacement codes 288.00 – 288.04 and 288.09 are effective for services performed on or after October 1, 2006.

Outpatient Psychiatric Services – L541
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 24, 25, and 26:

24. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
25. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
26. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, the deleted codes 333.7 and 995.2 have been replaced with the following codes:

Article Revisions:
Under the “Coding Guidelines” section added number 13:

13. The ICD-9-CM codes 333.7 and 995.2 were deleted effective September 30, 2006, and the replacement codes 333.71, 333.72, 333.79, 995.20-995.23, 995.27, and 995.29 are effective for services performed on or after October 1, 2006.