Issue 2006-05, May 2006

LCD and Article Revisions for May 2006  

Ambulatory Electrocardiographic Monitoring (Holter Monitor) - L666
LCD Revisions:

Under the “CMS National Coverage Policy” section, added numbers 5 and 6:

5. Change Request (CR) 3835, dated October 28, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Laboratory Specimens.
6. Change Request (CR) 4208, dated December 30, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Specimens. This instruction provides manual changes to conform with CR 3835 in various claims processing manual chapters.

This section was also updated in the article.

Under the “Bill Type Codes” section, removed 14X:

14X Hospital - other (Part B)

This section was also updated in the article.

Article Revisions:

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

8. The bill type 14X has been redefined and is no longer appropriate for this service. The removal of this code is effective for services performed on or after October 1, 2004 and will be implemented on April 3, 2006.

Magnetic Resonance Angiography - L513
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 8 and 9:

8. Change Request (CR.) 3835, dated October 28, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Laboratory Specimens.
9. Change Request (CR) 4208, dated December 30, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Specimens. This instruction provides manual changes to conform with CR 3835 in various claims processing manual chapters.

This section was also updated in the article.

Under the “Bill Type Codes” section, removed the bill type 14X:

14X Hospital - other (Part B)

This section was also updated in the article.

Article Revisions:
Under the “Coding Guidelines” section, added number 12:

12. The bill type 14X has been redefined and is no longer appropriate for this service. The removal of this code is effective for services performed on or after October 1, 2004 and will be implemented on April 3, 2006.

Radiation Therapy - 20908
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 5 and 6:

5. Change Request (CR) 3835, dated October 28, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Laboratory Specimens.
6. Change Request (CR) 4208, dated December 30, 2005. Redefined Type of Bill (TOB) 14X, for Nonpatient Specimens. This instruction provides manual changes to conform with CR 3835 in various claims processing manual chapters.

This section was also updated in the article.

Under the “Indications and Limitations of Coverage and/or Medical Necessity” section, added the following paragraph:

Neutron Beam Treatment Delivery (77422 and 77423)
High energy neutron beam treatment delivery has been demonstrated to be reasonable and necessary in the management of advanced salivary gland tumors. However, its usefulness in the treatment of other malignancies is investigational.

Under the “Bill Type Codes” section, removed the bill type 14X:

14X Hospital - other (Part B)

This section was also updated in the article.

Under the “CPT/HCPCS Codes” section, added the following codes:

77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallel-opposed ports with no blocks or simple blocking

77423 High energy neutron radiation treatment delivery; 1 or more isocenter(s) with coplanar or non-coplanar geometry with blocking and/or wedge, and/or compensator(s)

This section was also updated in the article.

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

The following ICD-9-CM codes are eligible for CPT codes 77422 and 77423

142.0 Malignant neoplasm of parotid gland

142.1 Malignant neoplasm of submandibular gland

142.2 Malignant neoplasm of sublingual gland

142.8 Malignant neoplasm of other major salivary glands

142.9 Malignant neoplasm of salivary gland unspecified

Article Revisions:

Under the “Coding Guidelines” section, added numbers 18 and 19:

18. The bill type 14X has been redefined and is no longer appropriate for this service. The removal of this code is effective for services performed on or after October 1, 2004 and will be implemented on April 3, 2006.
19. The new CPT codes 77422 and 77423 are effective for services performed on or after January 1, 2006.

Swallow Evaluation - L686

The LMRP for “Fiberoptic Endoscopic Evaluation of Swallowing with Sensory Testing” has been converted to an LCD and an article. The LCD and article title have been changed to “Swallow Evaluation.”

LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 1 through 3:

1. Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
   
2. Title XVIII of the Social Security Act, Section 1862(a)(1)(A). This section allows coverage and payment for only those services considered medically reasonable and necessary.
   
3. Title XVIII of the Social Security Act, Section 1833(e). This section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

This section was also added to the article.

Created the “Indications and Limitations of Coverage and/or Medical Necessity” section.

Under the “Bill Type Codes” section, added the following codes:

74X Outpatient Rehabilitation Facility (ORF)

75X Comprehensive Outpatient Rehabilitation Facility (CORF)

This section was also updated in the article.

Under the “CPT/HCPCS Codes” section, removed the following codes:

31575 Laryngoscopy, flexible fiberoptic, diagnostic

92520 Laryngeal function studies

92525 Evaluation of swallowing and oral function for feeding

The CPT codes 31575 and 92520 have been removed, as they are no longer appropriate for this policy. The CPT code 92525 was terminated effective December 31, 2002.

Under this section, the following CPT codes have been added:

70370 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique

70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording

74230 Swallowing function with cineradiography/videoradiography

92610 Evaluation of oral and pharyngeal swallowing function

92611 Motion fluoroscopic evaluation of swallowing function by cine or video recording

92612 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording

92614 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording

92616 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or with video recording

This section was also updated in the article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, the following codes were added to coordinate with Empire Part B:

150.1-150.9, 235.6, 239.1, 332.0, 332.1, 333.0, 333.2, 333.4-333.6, 333.81-333.84, 333.89, 333.90-333.93, 333.99, 335.20, 341.0, 341.2, 341.8, 341.9, 342.00-342.02, 342.10-342.12, 342.80-342.82, 342.90-342.92, 436, 438.10, 438.19-438.22, 438.50-438.53, 438.83, 464.01, 464.51, 478.30, 478.31, 478.32, 478.33, 478.34, 478.6, 530.0, 530.20, 530.21, 530.3, 530.6, 530.81, and 530.85.

Under the “Sources of Information” section, removed numbers 1 - 3, which are now numbers 1 - 3 under the “CMS National Coverage Policy” section. Renumbered 4 - 10 to 1 - 7. Added the following as numbers 8, 9, 10, and 11:

8. Gulchin, Ergun, M.D., “Approach to the Patient With Dysphagia,” Best Practice of Medicine, October 2002, Merck Medicus
9. Gallivan, Gregory J., Chest, Fees/FEESST and Videotape recording: “There’s More to This Than Meets the Eye,” December 14, 2002, Merck Medicus
10. American Gastroenterological Association (AGA) guideline: “Oropharyngeal Dysphagia,” Gastroenterology 1999; 116:454
11. Jan S. Lewin, PhD, “Speech and Swallowing Rehabilitation of the Patient with Head and Neck Cancer” @ www.utdol.com/application/topic

Number 11 is now number 12.

Article Revisions:

Removed the old “Statement of Purpose” and created a new section for “Article Text,” which includes the LCD Description, Coding Guidelines, Other Comments, and the CMS National Coverage Policy sections.