Revised - Updates - Policies - Part A

Revised Policies

The following are revised policies. Please access these policies in the CMS Medicare Coverage Database (MCD) . Be sure to note the effective date of the revision, as the revision will not appear in the Active policy until the effective date. Prior to the effective date, the revision can be found by selecting the link "Display Future Effective Documents" within the CMS Medicare Coverage Database (MCD) .

To access previous revised policy updates, please visit the CMS Medicare Coverage Database (MCD) .

March 2010

POLICIES WILL BE AVAILABLE ON THE CMS WEBSITE 02/25/10 AND ON THE WPS MEDICARE WEBSITE 02/26/10.

Policy Title	MCD Policy #	WPS Policy #	Effective Date
Ablative Therapy	L30312	GSURG-033	03/01/2010
CPT/HCPCS Codes Group II The following codes, when used as described below, are covered services. *47382 Ablation, one or more liver tumor(s); percutaneous, radiofrequency
Bone Mass Measurement Coding and Billing Guidelines	L28527	MS-004	03/01/2010
In the companion Coding and Billing Guidelines for LCD Bone Mass Measurement, added to the list of osteoporosis drug therapies, zolodronic acid (Reclast). This list is not intended as all-inclusive. Reclast is effective for DOS 08/17/2007 and after
Computerized Tomography (CAT Scans)	L28544	RAD-033	03/01/2010
03/01/2010, Addition of ICD-9 code 959.01 to cervical spine section (72125-72127) effective 01/01/2010
Flow Cytometry	L30161	PATH-016	11/16/2009
ICD-9 Codes that Support Medical Necessity Note: ICD-9 codes must be coded to the highest level of specificity. A. CPT codes 88184-88189 are indicated for the following conditions: 1. HIV infection (ICD-9 042, 079.51, 079.52, 079.53, V0.8), as defined by the Center for Disease Control criteria. 2. Leukemias (ICD-9 204.00-208.92) 3. Lymphomas (ICD-9 200.00-203.82) 4. Abnormal tissue, bone marrow, or blood histology when the results are suspicious for lymphoma, leukemia or MDS and where the physician must distinguish reactive from neoplastic conditions (ICD-9 238.6, 238.71- 238.79, 285.9, 287.30- 287.5, 795.4). 5. Platelet defects (ICD-9 287.1) 6. Postoperative monitoring of organ transplant patients (ICD-9 996.80-996.89, V42.0-V42.89). 7. Pretransplant evaluation of allogenic or autologous donor cells (V42.82) 8. Primary immunodeficiencies (ICD-9 279.10-279.9, 288.09, 334.8) 9. Monoclonal gammopathies (ICD-9 273.1, 273.3) 10. Certain anemias Acquired hemolytic anemia, unspecified 283.9 Constitutional aplastic anemia 284.0 Constitutional red cell aplasia 284.01 Other constitutional aplastic anemia 284.09 Pancytopenia -myelopthisis 284.1 - 284.2 Other specified aplastic anemia 284.89 Aplastic anemia, unspecified 284.9 Sideroblastic anemia 285.0 Anemia in neoplastic disease 285.22 Other anemia 285.8 - 285.9 11. Diseases of white blood cells Neutropenia, unspecified - neutropenia due to Infection 288.00 - 288.04 Other neutropenia 288.09 Functional disorders of polymorphonuclear Neutrophils - hemophagocytic syndromes 288.1 - 288.4 Leukocytopenia, unspecified - lymphocytopenia 288.50 - 288.51 Other decreased white blood cell count 288.59 Leukocytosis, unspecified - basophilia 288.60 - 288.65 Other elevated white blood cell count 288.69 Other specified diseases of white blood cells 288.8 - 288.9 12. Certain hemolytic anemias: Paroxysmal nocturnal hemoglobinuria (ICD-9 283.2) Portal vein thrombosis 452 Embolism of vein thrombosis, unspecified *453.9 Hereditary spherocytosis (ICD-9 282.0) Sickle cell (ICD-9 282.5, 282.60-282.69) HPFH (ICD-9 282.7) 13. Drug monitoring (ICD-9 V58.69) 14. Conditions associated with gene HLA B27 Reiter's syndrome (ICD-9 099.3) Uveitis (ICD-9 364.3) Psoriatic arthritis (ICD-9 696.0) Juvenile arthritis (ICD-9 714.30) Ankylosing spondylitis (ICD-9 720.0-720.9) Inflammatory bowel disease (ICD-9 555.0-556.9) 15. Splenomegaly (ICD-9 789.2) 16. Abdominal mass (ICD-9 789.30- 789.39)
Immune Globulins	L30147	INJ-012	03/01/2010
The following updates have been made to this LCD: 30. Stiff-man syndrome (333.91) IVIG may be used for patients with severe active illness for whom other interventions have been unsuccessful or intolerable. Documentation must support objective response for continued coverage each month or at longer intervals" Documentation Requirements Documentation must support objective response for continued coverage.
Noninvasive Vascular Testing (N.I.V.T.)	L28586	CV-033	05/01/2010
A. Training and Certification *5. Transcutaneous Oxygen measurement (93922-93923) may be performed by personnel possessing the following credentials obtained from the National Board of Diving and Hyperbaric Medicine Technology (NBDHMT): a. Certified Hyperbaric Technologist (CHT) b. Certified Hyperbaric Registered Nurse (CHRN)
Procedure Codes Payable for Podiatrist	NA	NA	NA
The following procedure codes have been added to the list of HCPCS codes approved as payable for podiatrists by the medical director staff. Policy Name & Number Added Codes Podiatry Code List 28039, 29581, 99304, 99305

February 2010

POLICIES WILL BE AVAILABLE ON THE CMS WEBSITE 01/28/10 AND ON THE WPS MEDICARE WEBSITE 01/29/10.

Policy Title

MCD Policy #

WPS Policy #

Effective Date

Bisphosphonate Drug Therapy

L30139

INJ-025

*10/16/2009

ICD-9 Codes that Support Medical Necessity

J3487	Zolendronic acid (Zoledronate) (Zometa), 198.5, 203.00, 203.01, 203.02, 275.42, 728.10-728.12, 731.0, 733.00 -733.09, 958.6
J2430	Pamidronate only 198.5, 203.00, 203.01, 203.02, 275.42, 731.0, , 728.10-728.12, 733-00 -733.09, 756.51, 756.54, 756.59, 958.6

The above marked ICD-9 codes were inadvertently left off the list of covered codes and are now being replaced.

Intra-articular Injections of Hyaluronan Billing and Coding Guidelines

L30149

INJ-033

01/01/2010

J7325 was removed from instruction #1 and #2 was added to the document.

HCPCS code J7321, J7323, and J7324 are per dose codes. When the injections are administered bilaterally, list J7321, J7323 or J7324 in item 24 (FAO-09 electronically) with a 2 in the unit's field.

J7321	Hyaluronan or Derivative, Hyalgan or Supartz, For Intra-Articular Injection, Per Dose
J7323	Hyaluronan or Derivative, Euflexxa, For Intra-Articular Injection, Per Dose
J7324	Hyaluronan or Derivative, Orthovisc, For Intra-Articular Injection, Per Dose

HCPC's J7325 is defined by milligrams.

J7325

Hyaluronan or Derivative, Synvisc or Synvisc-One, For Intra-Articular Injection, 1mg

^TM

Pulmonary Rehabilitation Services

L5738

PULM-001A

01/01/2010

Effective 01/01/2010 CPT Code G0424 was removed from this LCD, it does not apply in this setting.

January 2010

Policy Title	MCD Policy #	WPS Policy #	Effective Date
2010 CPT/HCPCS Code Update	Various	Various	New Codes: 01/01/2010 Deleted Codes: 12/31/2009
Please see the 2010 CPT/HCPCS Code Update article for details about the updates
CT Colonography (Virtual Colonoscopy [VC])	L30300	RAD-035	01/01/2010
Revision to the Documentation Requirements: 3. Medical records must be available to document a conventional colonoscopy has failed or documentation supporting the contraindication to an optical colonoscopy. These records must be available upon request. Removed "within 30 days" requirement."
Computed Coronary Tomography Angiography	L30288	RAD-034	01/01/2010
LCD Revisions: Effective 01/01/2010, CPT/HCPCS 2010 coding update; Removed specific CPT code designation requirement for a specific ICD-9 code designation, effective 08/16/2009. Coding and Billing Guidelines Revisions: 01/01/2010: Under section entitled Reasons for Denial, " sentence number four, deleted codes 0144T, 10150T and 0151T per 2010 CPT Coding updates and replaced with new 2010 CPT codes 75571 and 75573. Under section entitled "Coding and Billing Guidelines" added sentence number four.
Helicobacter Pylori	L30163	PATH-026	01/01/2010
Policy revision based on LCD reconsideration request, narrative revision to "Indications and Limitations" section of policy, revision does not change coverage or claims processing, effective date of narrative change is 02/01/2009. Added revenue code 031X for CPT codes 78267-78268 with effective date for claims processing of 09/16/2009.
Intra-articular Injections of Hyaluronan	L30149	INJ-033	01/01/2010
The following information has been added to the LCD: Utilization Guidelines Repeat treatments are considered medically necessary for patients being treated for osteoarthritis of the knee, who meet both of the following criteria: Significant improvement in knee pain and known improvement in functional capacity resulted from the previous series of injections which has been documented in the record; and At least six (6) months have elapsed since the prior series of injections. Documentation Requirements If subsequent courses of treatment are given, the medical records must support the effectiveness of the prior treatment and must clearly establish reduction of patient symptomatology and medication usage. This documentation must be submitted upon request. Claims submitted without requested supporting evidence in the medical record will be denied as being not medically necessary.
Routine Foot Care	L30322	FT-001	01/01/2010
*01/01/2009, Removed statement, per MBPM, Chapter 15, 290 - "or qualified non-physician practitioner", 12/01/2009, Removed all information except that which is directly related to routine foot care, added third list of ICD-9 codes where the patient has evidence of neuropathy, but no vascular impairment for which class finding modifiers are not required, added "Note: Painful ingrown toenail" in reference to ICD-9 code 703.0.
Vitamin B-12 Injections	L30145	INJ-004	01/01/2010
Revision to ICD-9 coding. Added codes V07.39 and V58.69 deleted V67.51. Revision based on correction of coding for prophylactic B-12 injection use for certain chemotherapy drugs that are B-12 deleting medications. Revision effective date 02/01/2010.

Page Last Updated: Monday, 22-Feb-2010 17:14:52 CST