Cytogenetic Studies (L30487)
Contractor Information
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Contractor Name Wisconsin Physicians Service Insurance Corporation |
Contractor Number 00951, 00952, 00953, 00954, 52280, 05101, 05201, 05301, 05401, 05102, 05202, 05302, 05402 |
Contractor Type Carrier - FI - MAC |
LCD Information
Document Information
L30487 LCD Title Cytogenetic Studies Contractor's Determination Number PATH-027 AMA CPT/ADA CDT Copyright Statement CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. |
Primary Geographic Jurisdiction
Oversight Region Original Determination Effective Date For services performed on or after 03/18/2010 Original Determination Ending Date Revision Effective Date For services performed on or after 10/01/2011 Revision Ending Date |
CMS National Coverage Policy
CMS National Coverage Policy
Title XVIII of the Social Security Act section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
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.
Title XVIII of the Social Security Act section 1862 (a)(1)(A). This section allows coverage and payment of those services that are considered to be medically reasonable and necessary.
Title XVIII of the Social Security Act section 1862 (a)(7). This section excludes routine physical examinations and services
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.
Indications and Limitations of Coverage and/or Medical Necessity
Discussion:
Cytogenetics is the study of chromosomes by light or fluorescent microscopy. Cytogenetic testing is used to study an individual's chromosome makeup. The term karyotyping refers to the arrangement of nuclear chromosomes in order from the largest to the smallest to analyze their number and structure. Variations in chromosome number or structure can produce a variety of clinical findings, including abnormalities of growth and intellect, congenital anomalies and, in the case of sex chromosome abnormalities ambiguous gender. Cytogenetic testing determines the number of chromosomes, defines the chromosome and examines the individual chromosomes for structural abnormalities such as deletions, duplications and translocations. Within the last 15 years cytogeneticists have incorporated molecular genetic techniques to identify structural chromosome abnormalities that are not visible using standard microscopy. These techniques include Fluorescence in situ hybridization (FISH), telomere-specific probes, spectral karyotyping, and comparative genomic hybridization. These techniques are used, when clinically indicated, to improve the accuracy and resolution of the standard karyotype. A normal karyotype consists of 22 pairs of autosomal chromosomes (numbered 1-22), and a pair of sex chromosomes: XY for the male and XX for the female. Karyotypes are reported using the International System for Cytogenetic Nomenclature which was last revised in 1995 (ICSN 1995).
Specimens for cytogenetic analysis can be obtained from a variety of tissues that yield cells that divide in culture including: peripheral blood, (lymphocytes; amniotic fluid (amniocytes); trophoblastic cells, chorionic villi; bone marrow; solid tumors, and cultured fibroblasts, usually obtained by skin biopsy. Also, fixed, paraffin embedded tissue and cytology specimens are used for FISH testing. The newer molecular cytogenetic techniques can be used even in non-dividing cells such as buccal cells obtained non-invasively from a cheek swab. Enough cells must be examined so that the chance of missing a cytogenetically distinct cell line (called mosaicism) is statistically low. For most clinical indications, 20 mitoses are examined and counted under direct microscopic visualization, and two are photographed or digitalized and karyotypes are prepared. Observation of aberrations usually prompts more extended scrutiny, and in many cases, further analysis of the original culture.
Indications
Cytogenetic studies may be undertaken to rule out a constitutional or acquired chromosomal abnormality. For most laboratories cytogenetic analyses now include standard G-banded chromosome analyses and/or molecular cytogenetic studies utilizing the method of fluorescence-in-situ-hybridization.
Constitutional chromosome abnormalities refer to those present at birth. Constitutional studies may be undertaken prenatally or postnatally:
Prenatal cytogenetic studies are indicated:
1. to rule out the presence of an abnormality in the fetus. Reasons for referral may include advanced maternal age (associated with an increased risk for trisomy), abnormalities observed on ultrasound, family history of a chromosome abnormality that increases risk for the current pregnancy). Cytogenetic studies are also performed on products of conception, to determine whether a chromosome abnormality was responsible for a fetal loss.
Postnatal cytogenetic studies are indicated:
1. to rule out a constitutional chromosome abnormality (present at birth) that may be associated with congenital anomalies, developmental delays, and/or mental retardation, and/or problems in sexual maturation or reproduction. The chromosome abnormalities involved in these disorders may be of number (gain or loss of a chromosome) or structure (e.g. deletions, duplications, derivative chromosomes resulting in both partial losses and gains of chromosomal material, inversions). Recently, with the advent of high resolution cytogenetics and supplemental studies by fluorescence-in-situ-hybridization (FISH) it has been possible to identify very subtle abnormalities that may be associated with neurologic and developmental issues (e.g. autism) rather than the multiple congenital anomalies. Many of these abnormalities represent so-called "microduplications or microdeletions". Specific FISH probes that can evaluate the presence or loss or duplication of specific gene regions involved in these duplications and deletions are now a part of routine cytogenetic practice (e.g. probes for Prader-Willi syndrome, DiGeorge syndrome, Williams's syndrome.)
2. to rule out the presence of a balanced chromosomal rearrangement (e.g. translocation) that puts the individual at risk for having a child with multiple congenital anomalies or for risk of recurrent miscarriage.
3. to rule out the presence of a chromosome instability syndrome that predisposes to development of malignancy (e.g. Fanconi anemia, Bloom syndrome, ataxia telangiectasia)
Acquired chromosome abnormalities refer to those that are typically acquired after birth, by a subpopulation of cells that is involved in a premalignant or malignant condition.
1. It is now recognized that the majority of hematologic malignancies are associated with clonal chromosomal abnormalities. Identifying the specific chromosome abnormality is now required for differential diagnosis of many of the lymphoid and myeloid leukemias and myelodysplastic syndromes. Additionally, as many of these chromosome abnormalities have been shown to have independent prognostic significance, identification of these abnormalities has become important for determining therapeutic regimens. For certain abnormalities (e.g. the Philadelphia chromosome and the 15;17 translocation) there are specific therapies targeted to the specific abnormalities.
2. Chromosome abnormalities for diagnosis and therapy decisions have also been identified in solid tumors including lymphomas, the small round blue cell tumors of childhood, and adult solid tumors such as breast and prostate, urinary bladder, lung and brain.
As with the constitutional studies, FISH studies targeted at identifying the specific gene rearrangement associated with the recurring chromosomal abnormality have become routine (e.g. the BCR/ABL fusion generated by the Philadelphia chromosome in CML and acute lymphoblastic leukemia, the PML/RARA fusion of the 15;17 translocation in APL)
Cytogenetics is the study of chromosomes by light or fluorescent microscopy. Cytogenetic testing is used to study an individual's chromosome makeup. The term karyotyping refers to the arrangement of nuclear chromosomes in order from the largest to the smallest to analyze their number and structure. Variations in chromosome number or structure can produce a variety of clinical findings, including abnormalities of growth and intellect, congenital anomalies and, in the case of sex chromosome abnormalities ambiguous gender. Cytogenetic testing determines the number of chromosomes, defines the chromosome and examines the individual chromosomes for structural abnormalities such as deletions, duplications and translocations. Within the last 15 years cytogeneticists have incorporated molecular genetic techniques to identify structural chromosome abnormalities that are not visible using standard microscopy. These techniques include Fluorescence in situ hybridization (FISH), telomere-specific probes, spectral karyotyping, and comparative genomic hybridization. These techniques are used, when clinically indicated, to improve the accuracy and resolution of the standard karyotype. A normal karyotype consists of 22 pairs of autosomal chromosomes (numbered 1-22), and a pair of sex chromosomes: XY for the male and XX for the female. Karyotypes are reported using the International System for Cytogenetic Nomenclature which was last revised in 1995 (ICSN 1995).
Specimens for cytogenetic analysis can be obtained from a variety of tissues that yield cells that divide in culture including: peripheral blood, (lymphocytes; amniotic fluid (amniocytes); trophoblastic cells, chorionic villi; bone marrow; solid tumors, and cultured fibroblasts, usually obtained by skin biopsy. Also, fixed, paraffin embedded tissue and cytology specimens are used for FISH testing. The newer molecular cytogenetic techniques can be used even in non-dividing cells such as buccal cells obtained non-invasively from a cheek swab. Enough cells must be examined so that the chance of missing a cytogenetically distinct cell line (called mosaicism) is statistically low. For most clinical indications, 20 mitoses are examined and counted under direct microscopic visualization, and two are photographed or digitalized and karyotypes are prepared. Observation of aberrations usually prompts more extended scrutiny, and in many cases, further analysis of the original culture.
Indications
Cytogenetic studies may be undertaken to rule out a constitutional or acquired chromosomal abnormality. For most laboratories cytogenetic analyses now include standard G-banded chromosome analyses and/or molecular cytogenetic studies utilizing the method of fluorescence-in-situ-hybridization.
Constitutional chromosome abnormalities refer to those present at birth. Constitutional studies may be undertaken prenatally or postnatally:
Prenatal cytogenetic studies are indicated:
1. to rule out the presence of an abnormality in the fetus. Reasons for referral may include advanced maternal age (associated with an increased risk for trisomy), abnormalities observed on ultrasound, family history of a chromosome abnormality that increases risk for the current pregnancy). Cytogenetic studies are also performed on products of conception, to determine whether a chromosome abnormality was responsible for a fetal loss.
Postnatal cytogenetic studies are indicated:
1. to rule out a constitutional chromosome abnormality (present at birth) that may be associated with congenital anomalies, developmental delays, and/or mental retardation, and/or problems in sexual maturation or reproduction. The chromosome abnormalities involved in these disorders may be of number (gain or loss of a chromosome) or structure (e.g. deletions, duplications, derivative chromosomes resulting in both partial losses and gains of chromosomal material, inversions). Recently, with the advent of high resolution cytogenetics and supplemental studies by fluorescence-in-situ-hybridization (FISH) it has been possible to identify very subtle abnormalities that may be associated with neurologic and developmental issues (e.g. autism) rather than the multiple congenital anomalies. Many of these abnormalities represent so-called "microduplications or microdeletions". Specific FISH probes that can evaluate the presence or loss or duplication of specific gene regions involved in these duplications and deletions are now a part of routine cytogenetic practice (e.g. probes for Prader-Willi syndrome, DiGeorge syndrome, Williams's syndrome.)
2. to rule out the presence of a balanced chromosomal rearrangement (e.g. translocation) that puts the individual at risk for having a child with multiple congenital anomalies or for risk of recurrent miscarriage.
3. to rule out the presence of a chromosome instability syndrome that predisposes to development of malignancy (e.g. Fanconi anemia, Bloom syndrome, ataxia telangiectasia)
Acquired chromosome abnormalities refer to those that are typically acquired after birth, by a subpopulation of cells that is involved in a premalignant or malignant condition.
1. It is now recognized that the majority of hematologic malignancies are associated with clonal chromosomal abnormalities. Identifying the specific chromosome abnormality is now required for differential diagnosis of many of the lymphoid and myeloid leukemias and myelodysplastic syndromes. Additionally, as many of these chromosome abnormalities have been shown to have independent prognostic significance, identification of these abnormalities has become important for determining therapeutic regimens. For certain abnormalities (e.g. the Philadelphia chromosome and the 15;17 translocation) there are specific therapies targeted to the specific abnormalities.
2. Chromosome abnormalities for diagnosis and therapy decisions have also been identified in solid tumors including lymphomas, the small round blue cell tumors of childhood, and adult solid tumors such as breast and prostate, urinary bladder, lung and brain.
As with the constitutional studies, FISH studies targeted at identifying the specific gene rearrangement associated with the recurring chromosomal abnormality have become routine (e.g. the BCR/ABL fusion generated by the Philadelphia chromosome in CML and acute lymphoblastic leukemia, the PML/RARA fusion of the 15;17 translocation in APL)
Coding Information
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
| 011x | Hospital Inpatient (Including Medicare Part A) |
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 014x | Hospital - Laboratory Services Provided to Non-patients |
| 071x | Clinic - Rural Health |
| 073x | Clinic - Freestanding |
| 085x | Critical Access Hospital |
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
CPT/HCPCS Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Revenue CodesContractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the article services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.
Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.
All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.
| 0300 | Laboratory - General Classification |
| 0309 | Laboratory - Other Laboratory |
| 0310 | Laboratory Pathology - General Classification |
| 0311 | Laboratory Pathology - Cytology |
| 0319 | Laboratory Pathology - Other Laboratory Pathology |
| 0971 | Professional Fees - Laboratory |
| 88230 | TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE |
| 88233 | TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; SKIN OR OTHER SOLID TISSUE BIOPSY |
| 88235 | TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; AMNIOTIC FLUID OR CHORIONIC VILLUS CELLS |
| 88237 | TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS |
| 88239 | TISSUE CULTURE FOR NEOPLASTIC DISORDERS; SOLID TUMOR |
| 88240 | CRYOPRESERVATION, FREEZING AND STORAGE OF CELLS, EACH CELL LINE |
| 88241 | THAWING AND EXPANSION OF FROZEN CELLS, EACH ALIQUOT |
| 88245 | CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE SISTER CHROMATID EXCHANGE (SCE), 20-25 CELLS |
| 88248 | CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; BASELINE BREAKAGE, SCORE 50-100 CELLS, COUNT 20 CELLS, 2 KARYOTYPES (EG, FOR ATAXIA TELANGIECTASIA, FANCONI ANEMIA, FRAGILE X) |
| 88249 | CHROMOSOME ANALYSIS FOR BREAKAGE SYNDROMES; SCORE 100 CELLS, CLASTOGEN STRESS (EG, DIEPOXYBUTANE, MITOMYCIN C, IONIZING RADIATION, UV RADIATION) |
| 88261 | CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITH BANDING |
| 88262 | CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITH BANDING |
| 88263 | CHROMOSOME ANALYSIS; COUNT 45 CELLS FOR MOSAICISM, 2 KARYOTYPES, WITH BANDING |
| 88264 | CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS |
| 88267 | CHROMOSOME ANALYSIS, AMNIOTIC FLUID OR CHORIONIC VILLUS, COUNT 15 CELLS, 1 KARYOTYPE, WITH BANDING |
| 88269 | CHROMOSOME ANALYSIS, IN SITU FOR AMNIOTIC FLUID CELLS, COUNT CELLS FROM 6-12 COLONIES, 1 KARYOTYPE, WITH BANDING |
| 88271 | MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH) |
| 88272 | MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 3-5 CELLS (EG, FOR DERIVATIVES AND MARKERS) |
| 88273 | MOLECULAR CYTOGENETICS; CHROMOSOMAL IN SITU HYBRIDIZATION, ANALYZE 10-30 CELLS (EG, FOR MICRODELETIONS) |
| 88274 | MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 25-99 CELLS |
| 88275 | MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION, ANALYZE 100-300 CELLS |
| 88280 | CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY |
| 88283 | CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDING TECHNIQUE (EG, NOR, C-BANDING) |
| 88285 | CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY |
| 88289 | CHROMOSOME ANALYSIS; ADDITIONAL HIGH RESOLUTION STUDY |
| 88291 | CYTOGENETICS AND MOLECULAR CYTOGENETICS, INTERPRETATION AND REPORT |
| 88299 | UNLISTED CYTOGENETIC STUDY |
ICD-9 Codes that Support Medical Necessity
Constitutional Cytogenetic Studies
88230, 88235, 88262, 88267, 88269, 88283, 88289
| 228.1 | LYMPHANGIOMA ANY SITE |
| 256.39 | OTHER OVARIAN FAILURE |
| 257.8 | OTHER TESTICULAR DYSFUNCTION |
| 259.0 | DELAY IN SEXUAL DEVELOPMENT AND PUBERTY NOT ELSEWHERE CLASSIFIED |
| 289.81 | PRIMARY HYPERCOAGULABLE STATE |
| 289.83 | MYELOFIBROSIS |
| 299.00 - 299.11 | AUTISTIC DISORDER, CURRENT OR ACTIVE STATE - CHILDHOOD DISINTEGRATIVE DISORDER, RESIDUAL STATE |
| 317 - 319 | MILD INTELLECTUAL DISABILITIES - UNSPECIFIED INTELLECTUAL DISABILITIES |
| 334.8 | OTHER SPINOCEREBELLAR DISEASES |
| 388.5 | DISORDERS OF ACOUSTIC NERVE |
| 606.0 | AZOOSPERMIA |
| 606.1 | OLIGOSPERMIA |
| 611.1 | HYPERTROPHY OF BREAST |
| 628.9 | INFERTILITY FEMALE OF UNSPECIFIED ORIGIN |
| 630 - 631.8 | HYDATIDIFORM MOLE - OTHER ABNORMAL PRODUCTS OF CONCEPTION |
| 632 | MISSED ABORTION |
| 634.00 - 634.92 | SPONTANEOUS ABORTION UNSPECIFIED COMPLICATED BY GENITAL TRACT AND PELVIC INFECTION - SPONTANEOUS ABORTION COMPLETE WITHOUT COMPLICATION |
| 646.33 | RECURRENT PREGNANCY LOSS, ANTEPARTUM CONDITION OR COMPLICATION |
| 653.70 | OTHER FETAL ABNORMALITY CAUSING DISPROPORTION UNSPECIFIED AS TO EPISODE OF CARE |
| 653.71 | OTHER FETAL ABNORMALITY CAUSING DISPROPORTION DELIVERED |
| 653.73 | OTHER FETAL ABNORMALITY CAUSING DISPROPORTION ANTEPARTUM |
| 655.10 - 655.13 | CHROMOSOMAL ABNORMALITY IN FETUS AFFECTING MANAGEMENT OF MOTHER UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - CHROMOSOMAL ABNORMALITY IN FETUS AFFECTING MANAGEMENT OF MOTHER ANTEPARTUM |
| 655.20 - 655.23 | HEREDITARY DISEASE IN FAMILY POSSIBLY AFFECTING FETUS AFFECTING MANAGEMENT OF MOTHER UNSPECIFIED AS TO EPISODE OF CARE IN PREGNANCY - HEREDITARY DISEASE IN FAMILY POSSIBLY AFFECTING FETUS AFFECTING MANAGEMENT OF MOTHER ANTEPARTUM CONDITION OR COMPLICATION |
| 656.40 | INTRAUTERINE DEATH AFFECTING MANAGEMENT OF MOTHER UNSPECIFIED AS TO EPISODE OF CARE |
| 656.41 | INTRAUTERINE DEATH AFFECTING MANAGEMENT OF MOTHER DELIVERED |
| 656.43 | INTRAUTERINE DEATH AFFECTING MANAGEMENT OF MOTHER ANTEPARTUM |
| 656.50 | POOR FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER UNSPECIFIED AS TO EPISODE OF CARE |
| 656.51 | POOR FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER DELIVERED |
| 656.53 | POOR FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER ANTEPARTUM CONDITION OR COMPLICATION |
| 656.60 | EXCESSIVE FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER UNSPECIFIED AS TO EPISODE OF CARE |
| 656.61 | EXCESSIVE FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER DELIVERED |
| 656.63 | EXCESSIVE FETAL GROWTH AFFECTING MANAGEMENT OF MOTHER ANTEPARTUM |
| 657.00 - 657.03 | POLYHYDRAMNIOS UNSPECIFIED AS TO EPISODE OF CARE - POLYHYDRAMNIOS ANTEPARTUM COMPLICATION |
| 658.00 - 658.03 | OLIGOHYDRAMNIOS UNSPECIFIED AS TO EPISODE OF CARE - OLIGOHYDRAMNIOS ANTEPARTUM |
| 659.50 - 659.63 | ELDERLY PRIMIGRAVIDA UNSPECIFIED AS TO EPISODE OF CARE - OTHER ADVANCED MATERNAL AGE ANTEPARTUM CONDITION OR COMPLICATION |
| 740.0 - 759.9 | ANENCEPHALUS - CONGENITAL ANOMALY UNSPECIFIED |
| 764.90 - 764.99 | FETAL GROWTH RETARDATION UNSPECIFIED WEIGHT - FETAL GROWTH RETARDATION 2500 GRAMS AND OVER |
| 779.9 | UNSPECIFIED CONDITION ORIGINATING IN THE PERINATAL PERIOD |
| 783.40 | UNSPECIFIED LACK OF NORMAL PHYSIOLOGICAL DEVELOPMENT |
| 783.41 | FAILURE TO THRIVE |
| 783.42 | DELAYED MILESTONES |
| 783.43 | SHORT STATURE |
| 792.3 | NONSPECIFIC ABNORMAL FINDINGS IN AMNIOTIC FLUID |
| 796.5 | ABNORMAL FINDING ON ANTENATAL SCREENING |
| V13.61 - V13.69 | PERSONAL HISTORY OF (CORRECTED) HYPOSPADIAS - PERSONAL HISTORY OF OTHER (CORRECTED) CONGENITAL MALFORMATIONS |
| V18.4 | FAMILY HISTORY OF INTELLECTUAL DISABILITIES |
| V18.51 | FAMILY HISTORY, COLONIC POLYPS |
| V18.61 | FAMILY HISTORY OF POLYCYSTIC KIDNEY |
| V18.9 | FAMILY HISTORY, GENETIC DISEASE CARRIER |
| V19.5 | FAMILY HISTORY OF CONGENITAL ANOMALIES |
| V23.2 | SUPERVISION OF HIGH-RISK PREGNANCY WITH HISTORY OF ABORTION |
| V23.81 - V23.82 | SUPERVISION OF HIGH-RISK PREGNANCY WITH ELDERLY PRIMIGRAVIDA - SUPERVISION OF HIGH-RISK PREGNANCY WITH ELDERLY MULTIGRAVIDA |
| V28.0 - V28.4 | ANTENATAL SCREENING FOR CHROMOSOMAL ANOMALIES BY AMNIOCENTESIS - ANTENATAL SCREENING FOR FETAL GROWTH RETARDATION USING ULTRASONICS |
| V83.01 | ASYMPTOMATIC HEMOPHILIA A CARRIER |
| V83.02 | SYMPTOMATIC HEMOPHILIA A CARRIER |
| V83.81 | CYSTIC FIBROSIS GENE CARRIER |
| V83.89 | OTHER GENETIC CARRIER STATUS |
88230, 88245, 88248, 88249, 88283
| 284.01 | CONSTITUTIONAL RED BLOOD CELL APLASIA |
| 284.09 | OTHER CONSTITUTIONAL APLASTIC ANEMIA |
| 334.8 | OTHER SPINOCEREBELLAR DISEASES |
| 757.39 | OTHER SPECIFIED CONGENITAL ANOMALIES OF SKIN |
| 759.89 | OTHER SPECIFIED CONGENITAL ANOMALIES |
88230, 88237, 88239, 88262, 88271, 88272, 88273, 88274, 88275, 88283
| 143.9 | MALIGNANT NEOPLASM OF GUM UNSPECIFIED |
| 152.1 - 152.8 | MALIGNANT NEOPLASM OF JEJUNUM - MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF SMALL INTESTINE |
| 158.0 | MALIGNANT NEOPLASM OF RETROPERITONEUM |
| 162.0 - 165.9 | MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE RESPIRATORY SYSTEM |
| 170.0 - 170.9 | MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE - MALIGNANT NEOPLASM OF BONE AND ARTICULAR CARTILAGE SITE UNSPECIFIED |
| 171.0 - 171.9 | MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK - MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE SITE UNSPECIFIED |
| 173.00 - 173.99 | UNSPECIFIED MALIGNANT NEOPLASM OF SKIN OF LIP - OTHER SPECIFIED MALIGNANT NEOPLASM OF SKIN, SITE UNSPECIFIED |
| 174.0 - 174.9 | MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST - MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE |
| 175.0 - 175.9 | MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST - MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST |
| 188.0 - 188.9 | MALIGNANT NEOPLASM OF TRIGONE OF URINARY BLADDER - MALIGNANT NEOPLASM OF BLADDER PART UNSPECIFIED |
| 189.0 - 189.9 | MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS - MALIGNANT NEOPLASM OF URINARY ORGAN SITE UNSPECIFIED |
| 190.1 | MALIGNANT NEOPLASM OF ORBIT |
| 191.0 - 191.9 | MALIGNANT NEOPLASM OF CEREBRUM EXCEPT LOBES AND VENTRICLES - MALIGNANT NEOPLASM OF BRAIN UNSPECIFIED SITE |
| 192.3 | MALIGNANT NEOPLASM OF SPINAL MENINGES |
| 197.0 - 197.8 | SECONDARY MALIGNANT NEOPLASM OF LUNG - SECONDARY MALIGNANT NEOPLASM OF OTHER DIGESTIVE ORGANS AND SPLEEN |
| 198.0 - 198.89 | SECONDARY MALIGNANT NEOPLASM OF KIDNEY - SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES |
| 200.00 - 202.98 | RETICULOSARCOMA UNSPECIFIED SITE - OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE INVOLVING LYMPH NODES OF MULTIPLE SITES |
| 203.00 - 203.02 | MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - MULTIPLE MYELOMA, IN RELAPSE |
| 203.10 - 203.12 | PLASMA CELL LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - PLASMA CELL LEUKEMIA, IN RELAPSE |
| 203.80 - 203.82 | OTHER IMMUNOPROLIFERATIVE NEOPLASMS, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE |
| 204.00 - 204.02 | ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE LYMPHOID LEUKEMIA, IN RELAPSE |
| 204.10 - 204.12 | CHRONIC LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - CHRONIC LYMPHOID LEUKEMIA, IN RELAPSE |
| 204.20 - 204.22 | SUBACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE LYMPHOID LEUKEMIA, IN RELAPSE |
| 204.80 - 204.82 | OTHER LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER LYMPHOID LEUKEMIA, IN RELAPSE |
| 204.90 - 204.92 | UNSPECIFIED LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LYMPHOID LEUKEMIA, IN RELAPSE |
| 205.00 - 205.92 | ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MYELOID LEUKEMIA, IN RELAPSE |
| 206.00 - 206.92 | ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED MONOCYTIC LEUKEMIA, IN RELAPSE |
| 207.00 - 207.82 | ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER SPECIFIED LEUKEMIA, IN RELAPSE |
| 208.00 - 208.02 | ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE |
| 208.10 - 208.12 | CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE |
| 208.20 - 208.22 | SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE |
| 208.80 - 208.82 | OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE |
| 208.90 - 208.92 | UNSPECIFIED LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION - UNSPECIFIED LEUKEMIA, IN RELAPSE |
| 209.00 - 209.69 | MALIGNANT CARCINOID TUMOR OF THE SMALL INTESTINE, UNSPECIFIED PORTION - BENIGN CARCINOID TUMOR OF OTHER SITES |
| 223.3 | BENIGN NEOPLASM OF BLADDER |
| 225.2 | BENIGN NEOPLASM OF CEREBRAL MENINGES |
| 230.0 | CARCINOMA IN SITU OF LIP ORAL CAVITY AND PHARYNX |
| 231.0 | CARCINOMA IN SITU OF LARYNX |
| 232.9 | CARCINOMA IN SITU OF SKIN SITE UNSPECIFIED |
| 233.0 | CARCINOMA IN SITU OF BREAST |
| 233.30 - 233.39 | CARCINOMA IN SITU, UNSPECIFIED FEMALE GENITAL ORGAN - CARCINOMA IN SITU, OTHER FEMALE GENITAL ORGAN |
| 233.7 | CARCINOMA IN SITU OF BLADDER |
| 233.9 | CARCINOMA IN SITU OF OTHER AND UNSPECIFIED URINARY ORGANS |
| 234.0 | CARCINOMA IN SITU OF EYE |
| 236.7 | NEOPLASM OF UNCERTAIN BEHAVIOR OF BLADDER |
| 238.4 | POLYCYTHEMIA VERA |
| 238.5 | NEOPLASM OF UNCERTAIN BEHAVIOR OF HISTIOCYTIC AND MAST CELLS |
| 238.6 | NEOPLASM OF UNCERTAIN BEHAVIOR OF PLASMA CELLS |
| 238.71 - 238.79 | ESSENTIAL THROMBOCYTHEMIA - OTHER LYMPHATIC AND HEMATOPOIETIC TISSUES |
| 239.2 | NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN |
| 239.3 | NEOPLASM OF UNSPECIFIED NATURE OF BREAST |
| 239.4 | NEOPLASM OF UNSPECIFIED NATURE OF BLADDER |
| 273.1 | MONOCLONAL PARAPROTEINEMIA |
| 273.3 | MACROGLOBULINEMIA |
| 281.0 - 281.9 | PERNICIOUS ANEMIA - UNSPECIFIED DEFICIENCY ANEMIA |
| 284.01 - 284.09 | CONSTITUTIONAL RED BLOOD CELL APLASIA - OTHER CONSTITUTIONAL APLASTIC ANEMIA |
| 284.19 | OTHER PANCYTOPENIA |
| 284.2 - 284.9 | MYELOPHTHISIS - APLASTIC ANEMIA UNSPECIFIED |
| 285.0 - 285.9 | SIDEROBLASTIC ANEMIA - ANEMIA UNSPECIFIED |
| 287.30 - 287.39 | PRIMARY THROMBOCYTOPENIA,UNSPECIFIED - OTHER PRIMARY THROMBOCYTOPENIA |
| 287.5 | THROMBOCYTOPENIA UNSPECIFIED |
| 288.09 | OTHER NEUTROPENIA |
| 288.50 - 288.59 | LEUKOCYTOPENIA, UNSPECIFIED - OTHER DECREASED WHITE BLOOD CELL COUNT |
| 288.60 - 288.69 | LEUKOCYTOSIS, UNSPECIFIED - OTHER ELEVATED WHITE BLOOD CELL COUNT |
| 289.89 | OTHER SPECIFIED DISEASES OF BLOOD AND BLOOD-FORMING ORGANS |
Diagnoses that Support Medical Necessity
There are no specific codes for the following syndromes. Use code 758.5, other conditions due to
autosomal anomalies, to indicate these conditions.
Microdeletion and other chromosomal syndromes:
- Angelman syndrome (associated with deletion of 15q11.2).
- Williams syndrome (associated with deletion of 7q11.3).
- Smith Magenis Syndrome: (deletion of 17p11.2): Mental retardation, dysmorphism, severe
- Miller Dieker and isolated lissencephaly (deletion of 17p13)
For the microdeletion syndromes listed above, the clinical referral is typically to:
Rule out Prader Willi or Angelmen, etc.
Solid tumors:
Cytogenetic studies may be useful in the following cancer types or to determine if a cancer fits into one of
these types. (Medicare does not use the M codes for billing purposes). See the list of icd-9 codes for solid
tumors listed above to bill for these types of cancer.
M9260/3 Ewing sarcoma
M8910/3 Embryonal rhabdomyosarcoma
M8920/3 Alveolar rhabdomyosarcoma
M9040/3 Alveolar soft part sarcoma
M9500/3 Neuroblastoma
M9391/3 Ependymoma
M940/3 Glioblastoma
M9380/3 Glioma
M9380/3 Gliosarcoma
M9470/3 Medulloblastoma
M9040 Synovial sarcoma
The following are referred for Her2Neu
M8500/3 Ductal carcinoma
M8541/3 Ductal carcinoma with Paget's disease
M8489/3 Collid/Mucinous carcinoma
M8500/2 Intraductal carcinoma
M8510/3 Lobular carcinoma
M8510/3 Medullary carcinoma
The following are for prostate related FISH:
M8120/2-3 Urothelial carcinoma
M8130/3 Transitional carcinoma
ICD-9 Codes that DO NOT Support Medical Necessity
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation
Diagnoses that DO NOT Support Medical Necessity
General Information
Documentation Requirements
- Documentation supporting the medical necessity of this item, such as ICD-9 codes, must be submitted with each claim. Claims submitted without such evidence will be denied as being not medically necessary.
- Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for performing the test. Additionally, a copy of the test results should be maintained in the medical records. This information is usually found in the history and physical, office/progress notes, and/or laboratory results.
- If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the test results and interpretation, along with copies of the ordering/referring physician's order for the studies.
- The physician must state the clinical indication/medical necessity for the study in his order for the test.
Appendices
- Documentation supporting the medical necessity of this item, such as ICD-9 codes, must be submitted with each claim. Claims submitted without such evidence will be denied as being not medically necessary.
- Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for performing the test. Additionally, a copy of the test results should be maintained in the medical records. This information is usually found in the history and physical, office/progress notes, and/or laboratory results.
- If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the test results and interpretation, along with copies of the ordering/referring physician's order for the studies.
- The physician must state the clinical indication/medical necessity for the study in his order for the test.
Genetic disorders
and failure of sexual development involve chromosomal abnormalities that
are stable over time, and, accordingly, payment for cytogenetic studies
for these abnormalities will be allowed once per lifetime.
This is in contrast to the malignancies, where repeat cytogenetic studies may be appropriate.
If a new technique (e.g., fluorescence in-situ hybridization) becomes available that was not available at the time of initial diagnosis, or if a supplemental study is able to be performed at a higher level of resolution and this increase the chances of detecting a chromosome abnormality, the follow-up study will be considered.
Sources of Information and Basis for Decision
This is in contrast to the malignancies, where repeat cytogenetic studies may be appropriate.
If a new technique (e.g., fluorescence in-situ hybridization) becomes available that was not available at the time of initial diagnosis, or if a supplemental study is able to be performed at a higher level of resolution and this increase the chances of detecting a chromosome abnormality, the follow-up study will be considered.
Sources of Information and Basis for Decision
General reference for Cytogenetic Studies: 2004 Standards and Guidelines for Clinical Genetics Laboratories E: Clinical Cytogenetics, American College of Medical Genetics.
For the Acquired Chromosome Studies:
1. Heim S and Mitelman F, 1995, Cancer Cytogenetics, John Wiley and Sons, New York, NY.
2. Jaffe ES et al ,2001, World Health Organization Classification of Tumours: Tumours of
Haematopoietic and Lymphoid Tissues. Oxford University Press
3. http://atlasgeneticsoncology.org//
For the Constitutional Chromosome Studies:
1. Jorde LB, Carey JC, Bamshad MJ, White Rl. 1999, Medical Genetics, NY.
2. McKinlay Gardner RJ and Sutherland GR, 2004, Chromosome Abnormalities and Genetic Counseling,
Oxford, NY
Advisory Committee Meeting Notes
General reference for Cytogenetic Studies: 2004 Standards and Guidelines for Clinical Genetics Laboratories E: Clinical Cytogenetics, American College of Medical Genetics.
For the Acquired Chromosome Studies:
1. Heim S and Mitelman F, 1995, Cancer Cytogenetics, John Wiley and Sons, New York, NY.
2. Jaffe ES et al ,2001, World Health Organization Classification of Tumours: Tumours of
Haematopoietic and Lymphoid Tissues. Oxford University Press
3. http://atlasgeneticsoncology.org//
For the Constitutional Chromosome Studies:
1. Jorde LB, Carey JC, Bamshad MJ, White Rl. 1999, Medical Genetics, NY.
2. McKinlay Gardner RJ and Sutherland GR, 2004, Chromosome Abnormalities and Genetic Counseling,
Oxford, NY
Advisory Committee Meeting Notes
Meeting Date:
Wisconsin: 09/25/2009
Illinois: 09/16/2009
Michigan: 09/09/2009
Minnesota: 09/24/2009
Iowa, Kansas, Missouri, Nebraska 10/08/2009
Jurisdictional Open Meeting 08/19/2009
Start Date of Comment Period
Meeting Date:
Wisconsin: 09/25/2009
Illinois: 09/16/2009
Michigan: 09/09/2009
Minnesota: 09/24/2009
Iowa, Kansas, Missouri, Nebraska 10/08/2009
Jurisdictional Open Meeting 08/19/2009
10/08/2009
End Date of Comment Period
11/23/2009
Start Date of Notice Period
10/01/2011
Revision History Number
x
Revision History Explanation
3/7/2010 - The description for Bill Type Code 73 was changed
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 14 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0300 was changed
8/1/2010 - The description for Revenue code 0309 was changed
8/1/2010 - The description for Revenue code 0310 was changed
8/1/2010 - The description for Revenue code 0311 was changed
8/1/2010 - The description for Revenue code 0319 was changed
8/1/2010 - The description for Revenue code 0971 was changed
09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Trailblazers (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
88230 descriptor was changed in Group 1
88233 descriptor was changed in Group 1
88235 descriptor was changed in Group 1
88237 descriptor was changed in Group 1
88239 descriptor was changed in Group 1
88245 descriptor was changed in Group 1
88248 descriptor was changed in Group 1
88249 descriptor was changed in Group 1
88261 descriptor was changed in Group 1
88262 descriptor was changed in Group 1
88263 descriptor was changed in Group 1
88264 descriptor was changed in Group 1
88267 descriptor was changed in Group 1
88269 descriptor was changed in Group 1
88271 descriptor was changed in Group 1
88272 descriptor was changed in Group 1
88273 descriptor was changed in Group 1
88274 descriptor was changed in Group 1
88275 descriptor was changed in Group 1
88285 descriptor was changed in Group 1
88289 descriptor was changed in Group 1
02/01/2011, Added code 88230 to the ICD-9 section, Constitutional Cytogenetic Studies retroactive to 03/18/2010
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 ICD-9 update
Reason for Change
04/19/2010-In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of American Somoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands were removed from this LCD because claims processing for those states are transitioning from FI Contractor Wisconsin Physician Services (WPS - 52280) to MAC Part A Contractor Palmetto.
8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 14 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed
8/1/2010 - The description for Revenue code 0300 was changed
8/1/2010 - The description for Revenue code 0309 was changed
8/1/2010 - The description for Revenue code 0310 was changed
8/1/2010 - The description for Revenue code 0311 was changed
8/1/2010 - The description for Revenue code 0319 was changed
8/1/2010 - The description for Revenue code 0971 was changed
09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.
10/18/2010 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Colorado, New Mexico, Oklahoma and Texas were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Trailblazers (04901).
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
88230 descriptor was changed in Group 1
88233 descriptor was changed in Group 1
88235 descriptor was changed in Group 1
88237 descriptor was changed in Group 1
88239 descriptor was changed in Group 1
88245 descriptor was changed in Group 1
88248 descriptor was changed in Group 1
88249 descriptor was changed in Group 1
88261 descriptor was changed in Group 1
88262 descriptor was changed in Group 1
88263 descriptor was changed in Group 1
88264 descriptor was changed in Group 1
88267 descriptor was changed in Group 1
88269 descriptor was changed in Group 1
88271 descriptor was changed in Group 1
88272 descriptor was changed in Group 1
88273 descriptor was changed in Group 1
88274 descriptor was changed in Group 1
88275 descriptor was changed in Group 1
88285 descriptor was changed in Group 1
88289 descriptor was changed in Group 1
02/01/2011, Added code 88230 to the ICD-9 section, Constitutional Cytogenetic Studies retroactive to 03/18/2010
02/21/2011 - In accordance with Section 911 of the Medicare Modernization Act of 2003, the states of Delaware, District of Columbia, Maryland, New Jersey and Pennsylvania were removed from this LCD because claims processing for these states are transitioning from FI Wisconsin Physician Service (WPS 52280) to MAC Part A contractor Highmark (12901).
08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update.
10/01/2011 ICD-9 update
This LCD has no Related Documents.
LCD Attachments
Coding and Billing (PDF - 14 KB )
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Page Last Updated: Thursday, 20-Oct-2011 15:49:03 CDT
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