Contractor Information. LCD Information. Local Coverage Determination (LCD): Cardiac Radionuclide Imaging (L33457) Document Information

Size: px
Start display at page:

Download "Contractor Information. LCD Information. Local Coverage Determination (LCD): Cardiac Radionuclide Imaging (L33457) Document Information"

Transcription

1 Local Coverage Determination (LCD): Cardiac Radionuclide Imaging (L33457) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor Name Contract Type Contract Number Jurisdiction State(s) Palmetto GBA A and B and HHH MAC MAC A J - M South Carolina Palmetto GBA A and B and HHH MAC MAC B J - M South Carolina Palmetto GBA A and B and HHH MAC MAC A J - M Virginia Palmetto GBA A and B and HHH MAC MAC B J - M Virginia Palmetto GBA A and B and HHH MAC MAC A J - M West Virginia Palmetto GBA A and B and HHH MAC MAC B J - M West Virginia Palmetto GBA A and B and HHH MAC MAC A J - M North Carolina Palmetto GBA A and B and HHH MAC MAC B J - M North Carolina Back to Top LCD Information Document Information LCD ID L33457 Original ICD-9 LCD ID L31700 LCD Title Cardiac Radionuclide Imaging Proposed LCD in Comment Period N/A Source Proposed LCD N/A AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT only copyright American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 12/02/2017 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A Printed on 12/6/2017. Page 1 of 27

2 The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright American Dental Association. All rights reserved. CDT and CDT-2016 are trademarks of the American Dental Association. UB-04 Manual. OFFICIAL UB-04 DATA SPECIFICATIONS MANUAL, 2014, is copyrighted by American Hospital Association ( AHA ), Chicago, Illinois. No portion of OFFICIAL UB-04 MANUAL may be reproduced, sorted in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior express, written consent of AHA. Health Forum reserves the right to change the copyright notice from time to time upon written notice to Company. CMS National Coverage Policy Title XVIII of the Social Security Act, 1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Title XVIII of the Social Security Act, 1862(a)(7) excludes routine physical examinations. Title XVIII of the Social Security Act, 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. CMS Internet-Only Manual, Pub , Medicare National Coverage Determinations Manual, Chapter 1, Part 4, CMS Internet-Only Manual, Pub , Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity The two types of radionuclide studies commonly used for cardiac evaluation are myocardial perfusion imaging and cardiac blood pool imaging (multiple gated acquisition scanning (MUGA), ventriculography). Myocardial perfusion imaging is used primarily for the evaluation of coronary artery disease. Ventriculography is sometimes referred to as MUGA or cardiac blood pool imaging and is primarily used to evaluate valvular disease and cardiomyopathies. Either type of study may be obtained at rest or with stress. Stress may be provided by exercise or with pharmacologic agents. Myocardial perfusion imaging is a diagnostic procedure that evaluates blood flow to cardiac muscle using radionuclides. A gamma camera is used to record images in planar or tomographic (single photon emission computed tomography {SPECT}) projections. Use of dual radiopharmaceuticals permits concurrent studies at rest and after stress, which are then compared and interpreted by a nuclear physician. Since the radiopharmaceutical accumulates in the myocardium in relation to blood flow, ischemic and infarcted myocardium can be detected. With the use of technetium based radiopharmaceuticals, the perfusion imaging may be linked to acquisition of first pass data to visualize blood flow through the right heart, lungs and left heart giving diagnostically useful information about cardiac chamber shunts, wall motion, cardiac output, ejection fraction, left ventricular volume, shunt fraction and valvular regurgitation. Effective for services performed on or after March 14, 1995, PET scans performed at rest or with pharmacological stress used for noninvasive imaging of the perfusion of the heart for the diagnosis and management of patients with known or suspected coronary artery disease using the FDA approved radiopharmaceutical Rubidium 82 (Rb 82) are covered, provided the requirements below are met: Printed on 12/6/2017. Page 2 of 27

3 The PET scan, whether at rest alone, or rest with stress, is performed in place of, but not in addition to, a single photon emission computed tomography (SPECT); or The PET scan whether at rest alone or rest with stress is used following a SPECT that was found to be inconclusive. In these cases the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the patient. (For purposes of this requirement, an inconclusive test is a test(s) whose results are equivocal, technically uninterpretable, or discordant with a patient s other clinical data and must be documented in the beneficiary s file.) The following studies are considered investigational and will not be covered: Ambulatory radionuclide cardiac monitoring Monoclonal anti-myosin imaging Radionuclide imaging of thrombi Radionuclide imaging of cardiac adrenergic nerves Myocardial Perfusion Imaging (CPT codes , 78491, 78492) Patients with a high pretest probability of disease are usually not candidates for this study unless determination of the size and reversibility of a defect are required for clinical decision making. Patients whose diagnosis is in question benefit most from this study. Patients with a low pretest probability of disease are usually not studied except when a prior exercise stress test by treadmill electrocardiogram (ECG) or echo is a presumed false positive. Stress myocardial perfusion imaging, preceded by satisfactory stress echocardiography (CPT code 93350), is not medically necessary. Indications for Myocardial Perfusion Imaging 1. Acute myocardial infarction - Myocardial perfusion imaging is not typically performed during the acute period of myocardial infarction, if the diagnosis is established by other means. In selected patients, imaging is appropriate in the assessment of: Disease severity Risk assessment and /or prognosis Efficacy of acute reperfusion therap Evidence of myocardial salvage Suspected infarction when the combination of history and other tests is not diagnostic. 2. Unstable angina - Myocardial perfusion imaging may be useful as an adjunct to other tests in the diagnosis or treatment of unstable angina only when the combination of history and other tests is not diagnostic. In selected patients, imaging is appropriate for: Identification of ischemia in the distribution of a known lesion or in remote areas Identification of the severity/extent of disease in patients with medically unstable angina or ongoing ischemia Measurement of left ventricular function. 3. Chronic ischemic heart disease - The use of myocardial perfusion imaging is well established in the diagnosis and management of coronary artery disease (CAD) and is covered in these situations: Printed on 12/6/2017. Page 3 of 27

4 Diagnosis of CAD, especially in patients with atypical chest pain Evaluation of abnormal or suspected false positive stress ECG Evaluation of other symptoms suspicious for the diagnosis of CAD such as syncope and ventricular arrhythmia Assessment of myocardial viability after revascularization or medical management Planning percutaneous transluminal coronary angioplasty (PTCA) to identify lesions causing ischemia, if unknown Evaluation of suspected or known CAD prior to high risk surgical procedure Identification of the presence, location, extent, and severity of myocardial ischemia Assessment of drug therapy Assessment of symptoms suggesting restenosis following PTCA Assessment of symptoms suggesting ischemia following Coronary Artery Bypass Graft (CABG) Follow up of symptomatic ischemic heart disease. 4. Congenital heart disease - Echocardiography is the method of choice for evaluating patients with known or suspected congenital heart disease. Selected patients may benefit from myocardial perfusion imaging when assessing for: Diagnosis of anomalies of the coronary circulation Kawasaki s disease 5. Post-transplant cardiac disease Assessment of coronary arteriopathy Evaluation for ventricular dysfunction with post-transplant rejection Cardiac Blood Pool Imaging (MUGA, Ventriculography) (CPT codes 78472, 78473, 78481, 78483, 78494, 78496) These services are allowed for the evaluation of ventricular size, wall motion, stroke volume, and ejection fraction when this information is medically necessary to direct further evaluation and management of the cardiac condition. Indications for Cardiac Blood Pool Imaging (MUGA, Ventriculography) : 1. Cardiomyopathy - Cardiac blood pool imaging (MUGA, ventriculography) is covered for: Diagnosis of hypertrophic cardiomyopathy and /or myocardial ischemia Differentiation of ischemic from non-ischemic cardiomyopathy. 2. Post-transplant cardiac disease Assessment of coronary arteriopathy Evaluation for ventricular dysfunction with post-transplant rejection 3. Assessment of cardiac function for cardiotoxic chemotherapy A. One baseline study is considered medically necessary prior to the initiation of cardiotoxic chemotherapy when one of the following conditions is met: 1. No echocardiogram is planned or performed 2. Prior echocardiogram is uninterpretable due to poor visualization window Printed on 12/6/2017. Page 4 of 27

5 B. Cardiac function monitoring during or at the completion of cardiotoxic chemotherapy. Cardiotoxic chemotherapy includes any of the following medications: 5-FU (5 fluorouracil) Adriamycin (doxorubicin) Avastin (bevacizumab) Cerubidine (daunorubicin) Clolar (clofarabine) Cytoxan (cyclophosphamide) Epirubicin (Pharmorubicin ) Gleevec (imatinib) Herceptin (trastuzumab) Ifex (ifosfamide) Mutamycin (mitomycin) Nexavar (sorafenib) Novantrone (mitoxantrone) Sutent (sunitinib) Taxol (paclitaxel) Taxotere (docetaxel) Tykerb (lapatinib) Valstar (valrubicin) Xeloda (capecitabine) Zavedos (idarubicin) Pharmacologic Stress Agents (HCPCS codes J0153, J0280, J0461, J1245, J1250) For those patients who are unable to reach % of their age predicted maximum heart rate by physiologic exercise, vasodilation can be achieved with the use of either dipyridamole or adenosine. Use of pharmacologic agents in myocardial perfusion imaging (CPT codes , 78491, 78492) is not a standard of care and is not medically necessary unless exercise is not possible. In some cases dobutamine may be used to effect stress through its inotropic effect. 1. Dipyridamole is typically administered intravenously at 0.57 mg/kg over a 4-minute period. The maximum dose should not exceed 60 mg. Since the dilation effect persists, after injection of the radiopharmaceutical, its effect is typically reversed with intravenous aminophylline, which must be available to reverse ischemia when it occurs. Dipyridamole is relatively contraindicated in patients with: Known bronchospastic lung disease (asthma) Systemic hypotension (systolic BP below 100 mm Hg.) Acute myocardial infarction less than 48 hours old Unstable angina 2. Adenosine is administered intravenously at 0.14 mg/kg/min over 6 minutes (0.84mg/kg). The vasodilation effect is short lived. Adenosine is contraindicated in patients with: Second or third degree AV block Sinus node disease, except for those with a functioning pacemaker Known or suspected bronchoconstrictive or bronchospastic lung disease Known hypersenstivity to adenosine 3. Dobutamine is administered intravenously, starting at mcg/kg/min and titrated to reach the maximum heart rate for 2-5 minutes. The maximum dose is 40 mcg/kg/min. Atropine may be added in appropriate doses IV. Dobutamine is contraindicated in patients with: Idiopathic subaortic stenosis Acute myocardial infarction Printed on 12/6/2017. Page 5 of 27

6 Physician Supervision Requirements Myocardial perfusion and blood pool imaging require general supervision by a qualified physician licensed to administer radioactive materials. Cardiology stress procedures (CPT codes ) performed in conjunction with nuclear myocardial perfusion imaging studies are covered by Medicare only when performed under the direct supervision of a qualified physician, who provides: Medical expertise required for performance of the test Medical treatment for complications and side effects of the test Medical services required as part of the test such as injections of medications Medical expertise in the interpretation of the cardiovascular stress test component, some of which has to be provided during the test and before the patient is discharged from the testing suite. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A Back to Top Coding Information Bill Type : 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. N/A Revenue : Contractors may specify Revenue to help providers identify those Revenue typically used to report this service. In most instances Revenue are purely advisory. Unless specified in the policy, services reported under other Revenue are equally subject to this coverage determination. Complete absence of all Revenue indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue. N/A CPT/HCPCS Group 1 Paragraph: NOTE: For Part A services only, the provider should bill the appropriate procedure code on the UB-04 for 11X bill type. Use CPT code in conjunction with CPT code Printed on 12/6/2017. Page 6 of 27

7 Group 1 : Ht muscle image spect sing Ht muscle image spect mult Ht muscle image planar sing Ht musc image planar mult Gated heart planar single Gated heart multiple Heart first pass single Heart first pass multiple Heart image (pet) single Heart image (pet) multiple Heart image spect Heart first pass add-on Group 2 Paragraph: HCPCS Group 2 : A4641 Radiopharm dx agent noc A9500 Tc99m sestamibi A9501 Technetium tc-99m teboroxime A9502 Tc99m tetrofosmin A9505 Tl201 thallium A9526 Nitrogen n-13 ammonia A9555 Rb82 rubidium Group 3 Paragraph: Pharmacologic Stress Agents Group 3 : J0153 Adenosine inj 1mg J0280 Aminophyllin 250 mg inj J0461 Atropine sulfate injection J1245 Dipyridamole injection J1250 Inj dobutamine hcl/250 mg ICD-10 that Support Medical Necessity Group 1 Paragraph: Use of these codes does not guarantee reimbursement. The patient s medical record must document that the coverage criteria in this policy have been met. Myocardial Perfusion Imaging CPT : , 78491, HCPCS : A4641, A9500, A9501, A9502, A9505, A9526, A9555, J0153, J0280, J0461, J1245, J1250 Group 1 : ICD-10 A18.84 Tuberculosis of heart E10.21 Type 1 diabetes mellitus with diabetic nephropathy E10.22 Type 1 diabetes mellitus with diabetic chronic kidney disease E10.29 Type 1 diabetes mellitus with other diabetic kidney complication Printed on 12/6/2017. Page 7 of 27

8 E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy E10.44 Type 1 diabetes mellitus with diabetic amyotrophy E10.49 Type 1 diabetes mellitus with other diabetic neurological complication E10.51 Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene E10.52 Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene E10.59 Type 1 diabetes mellitus with other circulatory complications E Type 1 diabetes mellitus with diabetic neuropathic arthropathy E11.21 Type 2 diabetes mellitus with diabetic nephropathy E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease E11.29 Type 2 diabetes mellitus with other diabetic kidney complication E Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema E Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene E11.59 Type 2 diabetes mellitus with other circulatory complications E Type 2 diabetes mellitus with diabetic neuropathic arthropathy E13.21 Other specified diabetes mellitus with diabetic nephropathy E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease E13.29 Other specified diabetes mellitus with other diabetic kidney complication E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified E13.41 Other specified diabetes mellitus with diabetic mononeuropathy E13.42 Other specified diabetes mellitus with diabetic polyneuropathy E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy E13.44 Other specified diabetes mellitus with diabetic amyotrophy E13.49 Other specified diabetes mellitus with other diabetic neurological complication E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene E13.59 Other specified diabetes mellitus with other circulatory complications E Other specified diabetes mellitus with diabetic neuropathic arthropathy G45.0 Vertebro-basilar artery syndrome G45.1 Carotid artery syndrome (hemispheric) G45.2 Multiple and bilateral precerebral artery syndromes G45.8 Other transient cerebral ischemic attacks and related syndromes G45.9 Transient cerebral ischemic attack, unspecified G46.0 Middle cerebral artery syndrome G46.1 Anterior cerebral artery syndrome G46.2 Posterior cerebral artery syndrome I20.0 Unstable angina I20.1 Angina with documented spasm I20.8 Other forms of angina I20.9 Angina, unspecified I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery I21.29 ST elevation (STEMI) myocardial infarction involving other sites Printed on 12/6/2017. Page 8 of 27

9 I21.4 Non-ST elevation (NSTEMI) myocardial infarction I21.9 Acute myocardial infarction, unspecified I21.A1 Myocardial infarction type 2 I21.A9 Other myocardial infarction type I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall I22.2 Subsequent non-st elevation (NSTEMI) myocardial infarction I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites I23.0 Hemopericardium as current complication following acute myocardial infarction I23.1 Atrial septal defect as current complication following acute myocardial infarction I23.2 Ventricular septal defect as current complication following acute myocardial infarction I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction I23.7 Postinfarction angina I23.8 Other current complications following acute myocardial infarction I24.0 Acute coronary thrombosis not resulting in myocardial infarction I24.1 Dressler's syndrome I24.8 Other forms of acute ischemic heart disease I24.9 Acute ischemic heart disease, unspecified I25.10 Atherosclerotic heart disease of native coronary artery without angina I Atherosclerotic heart disease of native coronary artery with unstable angina I Atherosclerotic heart disease of native coronary artery with angina with documented spasm I Atherosclerotic heart disease of native coronary artery with other forms of angina I Atherosclerotic heart disease of native coronary artery with unspecified angina I25.5 Ischemic cardiomyopathy I25.6 Silent myocardial ischemia I Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina I Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina with documented spasm I Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina I Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina I Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina I Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina with documented spasm I Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina I Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina I Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina I Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina with documented spasm I Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina I Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina I Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina I Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina with documented spasm I Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina I Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina I Atherosclerosis of native coronary artery of transplanted heart with unstable angina I Printed on 12/6/2017. Page 9 of 27

10 Atherosclerosis of native coronary artery of transplanted heart with angina with documented spasm I Atherosclerosis of native coronary artery of transplanted heart with other forms of angina I Atherosclerosis of native coronary artery of transplanted heart with unspecified angina I Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina I Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina with documented spasm I Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina I Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina I Atherosclerosis of other coronary artery bypass graft(s) with unstable angina I Atherosclerosis of other coronary artery bypass graft(s) with angina with documented spasm I Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina I Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina I Atherosclerosis of coronary artery bypass graft(s) without angina I Atherosclerosis of native coronary artery of transplanted heart without angina I Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina I25.82 Chronic total occlusion of coronary artery I25.84 Coronary atherosclerosis due to calcified coronary lesion I25.89 Other forms of chronic ischemic heart disease I25.9 Chronic ischemic heart disease, unspecified I27.20 Pulmonary hypertension, unspecified I27.21 Secondary pulmonary arterial hypertension I27.22 Pulmonary hypertension due to left heart disease I27.23 Pulmonary hypertension due to lung diseases and hypoxia I27.24 Chronic thromboembolic pulmonary hypertension I27.29 Other secondary pulmonary hypertension I27.83 Eisenmenger's syndrome I34.0 Nonrheumatic mitral (valve) insufficiency I34.1 Nonrheumatic mitral (valve) prolapse I34.2 Nonrheumatic mitral (valve) stenosis I34.8 Other nonrheumatic mitral valve disorders I34.9 Nonrheumatic mitral valve disorder, unspecified I35.0 Nonrheumatic aortic (valve) stenosis I35.1 Nonrheumatic aortic (valve) insufficiency I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency I35.8 Other nonrheumatic aortic valve disorders I35.9 Nonrheumatic aortic valve disorder, unspecified I36.0 Nonrheumatic tricuspid (valve) stenosis I36.1 Nonrheumatic tricuspid (valve) insufficiency I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency I36.8 Other nonrheumatic tricuspid valve disorders I36.9 Nonrheumatic tricuspid valve disorder, unspecified I37.0 Nonrheumatic pulmonary valve stenosis I37.1 Nonrheumatic pulmonary valve insufficiency I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency I37.8 Other nonrheumatic pulmonary valve disorders I37.9 Nonrheumatic pulmonary valve disorder, unspecified I38 Endocarditis, valve unspecified I39 Endocarditis and heart valve disorders in diseases classified elsewhere I42.0 Dilated cardiomyopathy I42.1 Obstructive hypertrophic cardiomyopathy I42.2 Other hypertrophic cardiomyopathy I42.3 Endomyocardial (eosinophilic) disease I42.4 Endocardial fibroelastosis I42.5 Other restrictive cardiomyopathy Printed on 12/6/2017. Page 10 of 27

11 I42.6 Alcoholic cardiomyopathy I42.7 Cardiomyopathy due to drug and external agent I42.8 Other cardiomyopathies I42.9 Cardiomyopathy, unspecified I43 Cardiomyopathy in diseases classified elsewhere I44.0 Atrioventricular block, first degree I44.30 Unspecified atrioventricular block I44.39 Other atrioventricular block I44.4 Left anterior fascicular block I44.5 Left posterior fascicular block I44.60 Unspecified fascicular block I44.69 Other fascicular block I44.7 Left bundle-branch block, unspecified I45.0 Right fascicular block I45.10 Unspecified right bundle-branch block I45.19 Other right bundle-branch block I45.2 Bifascicular block I45.3 Trifascicular block I45.4 Nonspecific intraventricular block I45.5 Other specified heart block I47.1 Supraventricular tachycardia I47.9 Paroxysmal tachycardia, unspecified I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter I48.4 Atypical atrial flutter I48.91 Unspecified atrial fibrillation I48.92 Unspecified atrial flutter I49.1 Atrial premature depolarization I49.2 Junctional premature depolarization I49.3 Ventricular premature depolarization I49.40 Unspecified premature depolarization I49.49 Other premature depolarization I49.5 Sick sinus syndrome I49.8 Other specified cardiac arrhythmias I49.9 Cardiac arrhythmia, unspecified I50.1 Left ventricular failure, unspecified I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.30 Unspecified diastolic (congestive) heart failure I50.31 Acute diastolic (congestive) heart failure I50.32 Chronic diastolic (congestive) heart failure I50.33 Acute on chronic diastolic (congestive) heart failure I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure I Right heart failure, unspecified I Acute right heart failure I Chronic right heart failure I Acute on chronic right heart failure I Right heart failure due to left heart failure I50.82 Biventricular heart failure I50.83 High output heart failure I50.84 End stage heart failure Printed on 12/6/2017. Page 11 of 27

12 I50.89 Other heart failure I50.9 Heart failure, unspecified I51.0 Cardiac septal defect, acquired I51.1 Rupture of chordae tendineae, not elsewhere classified I51.2 Rupture of papillary muscle, not elsewhere classified I51.3 Intracardiac thrombosis, not elsewhere classified I51.4 Myocarditis, unspecified I51.5 Myocardial degeneration I51.7 Cardiomegaly I51.81 Takotsubo syndrome I51.89 Other ill-defined heart diseases I Cerebral infarction due to thrombosis of right carotid artery I Cerebral infarction due to thrombosis of left carotid artery I Cerebral infarction due to embolism of right carotid artery I Cerebral infarction due to embolism of left carotid artery I Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries I Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries I Cerebral infarction due to thrombosis of right middle cerebral artery I Cerebral infarction due to thrombosis of left middle cerebral artery I Cerebral infarction due to thrombosis of right anterior cerebral artery I Cerebral infarction due to thrombosis of left anterior cerebral artery I Cerebral infarction due to thrombosis of right posterior cerebral artery I Cerebral infarction due to thrombosis of left posterior cerebral artery I Cerebral infarction due to thrombosis of right cerebellar artery I Cerebral infarction due to thrombosis of left cerebellar artery I63.39 Cerebral infarction due to thrombosis of other cerebral artery I Cerebral infarction due to embolism of right middle cerebral artery I Cerebral infarction due to embolism of left middle cerebral artery I Cerebral infarction due to embolism of right anterior cerebral artery I Cerebral infarction due to embolism of left anterior cerebral artery I Cerebral infarction due to embolism of right posterior cerebral artery I Cerebral infarction due to embolism of left posterior cerebral artery I Cerebral infarction due to embolism of right cerebellar artery I Cerebral infarction due to embolism of left cerebellar artery I63.49 Cerebral infarction due to embolism of other cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery I Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery I Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic I63.8 Other cerebral infarction I63.9 Cerebral infarction, unspecified I65.21 Occlusion and stenosis of right carotid artery I65.22 Occlusion and stenosis of left carotid artery I65.23 Occlusion and stenosis of bilateral carotid arteries I66.01 Occlusion and stenosis of right middle cerebral artery I66.02 Occlusion and stenosis of left middle cerebral artery I66.03 Occlusion and stenosis of bilateral middle cerebral arteries I66.11 Occlusion and stenosis of right anterior cerebral artery I66.12 Occlusion and stenosis of left anterior cerebral artery I66.13 Occlusion and stenosis of bilateral anterior cerebral arteries I66.21 Occlusion and stenosis of right posterior cerebral artery Printed on 12/6/2017. Page 12 of 27

13 I66.22 Occlusion and stenosis of left posterior cerebral artery I66.23 Occlusion and stenosis of bilateral posterior cerebral arteries I66.3 Occlusion and stenosis of cerebellar arteries I66.8 Occlusion and stenosis of other cerebral arteries I Reversible cerebrovascular vasoconstriction syndrome I Other cerebrovascular vasospasm and vasoconstriction I67.89 Other cerebrovascular disease I Unspecified atherosclerosis of native arteries of extremities, right leg I Unspecified atherosclerosis of native arteries of extremities, left leg I Unspecified atherosclerosis of native arteries of extremities, bilateral legs I Unspecified atherosclerosis of native arteries of extremities, other extremity I Atherosclerosis of native arteries of extremities with intermittent claudication, right leg I Atherosclerosis of native arteries of extremities with intermittent claudication, left leg I Atherosclerosis of native arteries of extremities with intermittent claudication, bilateral legs I Atherosclerosis of native arteries of extremities with intermittent claudication, other extremity I Atherosclerosis of native arteries of extremities with rest pain, right leg I Atherosclerosis of native arteries of extremities with rest pain, left leg I Atherosclerosis of native arteries of extremities with rest pain, bilateral legs I Atherosclerosis of native arteries of extremities with rest pain, other extremity I Atherosclerosis of native arteries of extremities with gangrene, right leg I Atherosclerosis of native arteries of extremities with gangrene, left leg I Atherosclerosis of native arteries of extremities with gangrene, bilateral legs I Atherosclerosis of native arteries of extremities with gangrene, other extremity I Other atherosclerosis of native arteries of extremities, right leg I Other atherosclerosis of native arteries of extremities, left leg I Other atherosclerosis of native arteries of extremities, bilateral legs I Other atherosclerosis of native arteries of extremities, other extremity I Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg I Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg I Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs I Unspecified atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, right leg I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, left leg I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with intermittent claudication, other extremity I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, right leg I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, left leg I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, bilateral legs I Atherosclerosis of unspecified type of bypass graft(s) of the extremities with rest pain, other extremity I Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, right leg I Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, left leg I Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, bilateral legs I Other atherosclerosis of unspecified type of bypass graft(s) of the extremities, other extremity I Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg I Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg I Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs I Unspecified atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity I Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, right leg I Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, left leg I Printed on 12/6/2017. Page 13 of 27

14 Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, bilateral legs I Atherosclerosis of autologous vein bypass graft(s) of the extremities with intermittent claudication, other extremity I Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg I Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, left leg I Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, bilateral legs I Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, other extremity I Other atherosclerosis of autologous vein bypass graft(s) of the extremities, right leg I Other atherosclerosis of autologous vein bypass graft(s) of the extremities, left leg I Other atherosclerosis of autologous vein bypass graft(s) of the extremities, bilateral legs I Other atherosclerosis of autologous vein bypass graft(s) of the extremities, other extremity I Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg I Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg I Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs I Unspecified atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, right leg I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, left leg I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, bilateral legs I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with intermittent claudication, other extremity I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, right leg I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, left leg I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, bilateral legs I Atherosclerosis of nonautologous biological bypass graft(s) of the extremities with rest pain, other extremity I Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, right leg I Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, left leg I Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, bilateral legs I Other atherosclerosis of nonautologous biological bypass graft(s) of the extremities, other extremity I Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg I Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg I Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs I Unspecified atherosclerosis of nonbiological bypass graft(s) of the extremities, other extremity I Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, right leg I Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, left leg I Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, bilateral legs I Atherosclerosis of nonbiological bypass graft(s) of the extremities with intermittent claudication, other extremity I Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, right leg I Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, left leg I Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, bilateral legs I Atherosclerosis of nonbiological bypass graft(s) of the extremities with rest pain, other extremity I Other atherosclerosis of nonbiological bypass graft(s) of the extremities, right leg I Other atherosclerosis of nonbiological bypass graft(s) of the extremities, left leg I Other atherosclerosis of nonbiological bypass graft(s) of the extremities, bilateral legs I Other atherosclerosis of nonbiological bypass graft(s) of the extremities, other extremity Printed on 12/6/2017. Page 14 of 27

15 I Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, right leg I Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, left leg I Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs I Unspecified atherosclerosis of other type of bypass graft(s) of the extremities, other extremity I Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, right leg I Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, left leg I Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, bilateral legs I Atherosclerosis of other type of bypass graft(s) of the extremities with intermittent claudication, other extremity I Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg I Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg I Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs I Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity I Other atherosclerosis of other type of bypass graft(s) of the extremities, right leg I Other atherosclerosis of other type of bypass graft(s) of the extremities, left leg I Other atherosclerosis of other type of bypass graft(s) of the extremities, bilateral legs I Other atherosclerosis of other type of bypass graft(s) of the extremities, other extremity I70.8 Atherosclerosis of other arteries I70.91 Generalized atherosclerosis I70.92 Chronic total occlusion of artery of the extremities I71.00 Dissection of unspecified site of aorta I71.01 Dissection of thoracic aorta I71.02 Dissection of abdominal aorta I71.03 Dissection of thoracoabdominal aorta I71.1 Thoracic aortic aneurysm, ruptured I71.2 Thoracic aortic aneurysm, without rupture I71.3 Abdominal aortic aneurysm, ruptured I71.4 Abdominal aortic aneurysm, without rupture I71.5 Thoracoabdominal aortic aneurysm, ruptured I71.6 Thoracoabdominal aortic aneurysm, without rupture I71.8 Aortic aneurysm of unspecified site, ruptured I71.9 Aortic aneurysm of unspecified site, without rupture I74.01 Saddle embolus of abdominal aorta I74.09 Other arterial embolism and thrombosis of abdominal aorta I74.10 Embolism and thrombosis of unspecified parts of aorta I74.11 Embolism and thrombosis of thoracic aorta I74.19 Embolism and thrombosis of other parts of aorta I74.2 Embolism and thrombosis of arteries of the upper extremities I74.3 Embolism and thrombosis of arteries of the lower extremities I74.5 Embolism and thrombosis of iliac artery I74.8 Embolism and thrombosis of other arteries I79.0 Aneurysm of aorta in diseases classified elsewhere I97.0 Postcardiotomy syndrome I Postprocedural cardiac insufficiency following cardiac surgery I Postprocedural cardiac insufficiency following other surgery I Postprocedural cardiac arrest following cardiac surgery I Postprocedural cardiac arrest following other surgery I Postprocedural heart failure following cardiac surgery I Postprocedural heart failure following other surgery I Other postprocedural cardiac functional disturbances following cardiac surgery I Other postprocedural cardiac functional disturbances following other surgery J80 Acute respiratory distress syndrome M32.11 Endocarditis in systemic lupus erythematosus Q20.0 Common arterial trunk Q20.1 Double outlet right ventricle Printed on 12/6/2017. Page 15 of 27

16 Q20.2 Double outlet left ventricle Q20.3 Discordant ventriculoarterial connection Q20.4 Double inlet ventricle Q20.5 Discordant atrioventricular connection Q20.6 Isomerism of atrial appendages Q20.8 Other congenital malformations of cardiac chambers and connections Q20.9 Congenital malformation of cardiac chambers and connections, unspecified Q21.0 Ventricular septal defect Q21.1 Atrial septal defect Q21.2 Atrioventricular septal defect Q21.3 Tetralogy of Fallot Q21.4 Aortopulmonary septal defect Q21.8 Other congenital malformations of cardiac septa Q21.9 Congenital malformation of cardiac septum, unspecified Q22.0 Pulmonary valve atresia Q22.1 Congenital pulmonary valve stenosis Q22.2 Congenital pulmonary valve insufficiency Q22.3 Other congenital malformations of pulmonary valve Q22.4 Congenital tricuspid stenosis Q22.5 Ebstein's anomaly Q22.6 Hypoplastic right heart syndrome Q22.8 Other congenital malformations of tricuspid valve Q22.9 Congenital malformation of tricuspid valve, unspecified Q23.0 Congenital stenosis of aortic valve Q23.1 Congenital insufficiency of aortic valve Q23.2 Congenital mitral stenosis Q23.3 Congenital mitral insufficiency Q23.4 Hypoplastic left heart syndrome Q23.8 Other congenital malformations of aortic and mitral valves Q23.9 Congenital malformation of aortic and mitral valves, unspecified Q24.0 Dextrocardia Q24.1 Levocardia Q24.2 Cor triatriatum Q24.3 Pulmonary infundibular stenosis Q24.4 Congenital subaortic stenosis Q24.5 Malformation of coronary vessels Q24.6 Congenital heart block Q24.8 Other specified congenital malformations of heart Q24.9 Congenital malformation of heart, unspecified R00.1 Bradycardia, unspecified R06.00 Dyspnea, unspecified R06.01 Orthopnea R06.02 Shortness of breath R06.09 Other forms of dyspnea R06.2 Wheezing R06.89 Other abnormalities of breathing R07.2 Precordial pain R07.82 Intercostal pain R07.89 Other chest pain R07.9 Chest pain, unspecified R50.2 Drug induced fever R50.81 Fever presenting with conditions classified elsewhere R50.9 Fever, unspecified R55 Syncope and collapse R57.0 Cardiogenic shock R57.9 Shock, unspecified R94.30 Abnormal result of cardiovascular function study, unspecified R94.31 Abnormal electrocardiogram [ECG] [EKG] Printed on 12/6/2017. Page 16 of 27

17 R94.39 Abnormal result of other cardiovascular function study T82.398A Other mechanical complication of other vascular grafts, initial encounter T82.398D Other mechanical complication of other vascular grafts, subsequent encounter T82.398S Other mechanical complication of other vascular grafts, sequela T86.20 Unspecified complication of heart transplant T86.21 Heart transplant rejection T86.22 Heart transplant failure T86.23 Heart transplant infection T Cardiac allograft vasculopathy T Other complications of heart transplant T86.30 Unspecified complication of heart-lung transplant T86.31 Heart-lung transplant rejection T86.32 Heart-lung transplant failure T86.33 Heart-lung transplant infection T86.39 Other complications of heart-lung transplant Z01.810* Encounter for preprocedural cardiovascular examination Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm Z Other long term (current) drug therapy Z95.1 Presence of aortocoronary bypass graft Z95.5 Presence of coronary angioplasty implant and graft Z98.61 Coronary angioplasty status Group 1 Medical Necessity ICD-10 Asterisk Explanation: *NOTE: Z is to be used to code claims for pre-operative evaluation. This code is NOT appropriate for establishing a baseline prior to the administration of cardiotoxic chemotherapy. Group 2 Paragraph: Cardiac Blood Pool Imaging (MUGA, ventriculography) CPT : 78472, 78473, 78481, 78483, 78494, Group 2 : ICD-10 A18.84 Tuberculosis of heart C58 Malignant neoplasm of placenta C81.10 Nodular sclerosis Hodgkin lymphoma, unspecified site C81.11 Nodular sclerosis Hodgkin lymphoma, lymph nodes of head, face, and neck C81.12 Nodular sclerosis Hodgkin lymphoma, intrathoracic lymph nodes C81.13 Nodular sclerosis Hodgkin lymphoma, intra-abdominal lymph nodes C81.14 Nodular sclerosis Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.15 Nodular sclerosis Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.16 Nodular sclerosis Hodgkin lymphoma, intrapelvic lymph nodes C81.17 Nodular sclerosis Hodgkin lymphoma, spleen C81.18 Nodular sclerosis Hodgkin lymphoma, lymph nodes of multiple sites C81.19 Nodular sclerosis Hodgkin lymphoma, extranodal and solid organ sites C81.20 Mixed cellularity Hodgkin lymphoma, unspecified site C81.21 Mixed cellularity Hodgkin lymphoma, lymph nodes of head, face, and neck C81.22 Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes C81.23 Mixed cellularity Hodgkin lymphoma, intra-abdominal lymph nodes C81.24 Mixed cellularity Hodgkin lymphoma, lymph nodes of axilla and upper limb C81.25 Mixed cellularity Hodgkin lymphoma, lymph nodes of inguinal region and lower limb C81.26 Mixed cellularity Hodgkin lymphoma, intrapelvic lymph nodes C81.27 Mixed cellularity Hodgkin lymphoma, spleen C81.28 Mixed cellularity Hodgkin lymphoma, lymph nodes of multiple sites Printed on 12/6/2017. Page 17 of 27

CMS Limitations Guide - Cardiovascular Services

CMS Limitations Guide - Cardiovascular Services CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

CMS Limitations Guide - Cardiovascular Services

CMS Limitations Guide - Cardiovascular Services CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

CMS Limitations Guide - Radiology Services

CMS Limitations Guide - Radiology Services CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

Common Codes for ICD-10

Common Codes for ICD-10 Common Codes for ICD-10 Specialty: Cardiology *Always utilize more specific codes first. ABNORMALITIES OF HEART RHYTHM ICD-9-CM Codes: 427.81, 427.89, 785.0, 785.1, 785.3 R00.0 Tachycardia, unspecified

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): HOMOCYSTeine Level, Serum (L34419) Document Information

Contractor Information. LCD Information. Local Coverage Determination (LCD): HOMOCYSTeine Level, Serum (L34419) Document Information Local Coverage Determination (LCD): HOMOCYSTeine Level, Serum (L34419) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor

More information

Cardiology/Cardiothoracic

Cardiology/Cardiothoracic Cardiology/Cardiothoracic ICD-9-CM to ICD-10-CM Code Mapper 800-334-5724 www.contexomedia.com 2013 ICD-9-CM 272.0 Pure hypercholesterolemia 272.2 Mixed hyperlipidemia 272.4 Other and hyperlipidemia 278.00

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Cardiovascular Nuclear Medicine (L35083) MP-055-MC-PA Medical Management Provider Notice Date: 05/01/2018 Issue Date: 06/01/2018

More information

Cardiovascular nuclear imaging employs non-invasive techniques to assess alterations in coronary artery flow, and ventricular function.

Cardiovascular nuclear imaging employs non-invasive techniques to assess alterations in coronary artery flow, and ventricular function. National Imaging Associates, Inc. Clinical guidelines CARDIOVASCULAR NUCLEAR MEDICINE -MYOCARDIAL PERFUSION IMAGING -MUGA CPT4 Codes: Refer to pages 6-9 LCD ID Number: L33960 J 15 = KY, OH Responsible

More information

CMS Limitations Guide - Cardiovascular Services

CMS Limitations Guide - Cardiovascular Services CMS Limitations Guide - Cardiovascular Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

Cardiovascular nuclear imaging employs non-invasive techniques to assess alterations in coronary artery flow, and ventricular function.

Cardiovascular nuclear imaging employs non-invasive techniques to assess alterations in coronary artery flow, and ventricular function. National Imaging Associates, Inc. Clinical guidelines CARDIOVASCULAR NUCLEAR MEDICINE -MYOCARDIAL PERFUSION IMAGING -MUGA Original Date: October 2015 Page 1 of 9 FOR CMS (MEDICARE) MEMBERS ONLY CPT4 Codes:

More information

Lnformation Coverage Guidance

Lnformation Coverage Guidance Lnformation Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Abstract: B-type natriuretic peptide (BNP) is a cardiac neurohormone produced mainly in the left ventricle. It

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Magnetic Resonance Angiography (L34424) Document Information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Magnetic Resonance Angiography (L34424) Document Information Local Coverage Determination (LCD): Magnetic Resonance Angiography (L34424) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor

More information

Local Coverage Determination (LCD) for Cardiac Catheterization (L29090)

Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Local Coverage Determination (LCD) for Cardiac Catheterization (L29090) Contractor Information Contractor Name First Coast Service Options, Inc. Contractor Number 09102 Contractor Type MAC - Part B LCD

More information

LCD Information Document Information LCD ID Number L30046

LCD Information Document Information LCD ID Number L30046 Local Coverage Determination (LCD): Pathology and Laboratory: B-type Natriuretic Peptide (BNP) Testing (L30046) LCD Information Document Information LCD ID Number L30046 LCD Title Pathology and Laboratory:

More information

LCD L B-type Natriuretic Peptide (BNP) Assays

LCD L B-type Natriuretic Peptide (BNP) Assays LCD L30559 - B-type Natriuretic Peptide (BNP) Assays Contractor Information Contractor Name: Novitas Solutions, Inc. Contractor Number(s): 12501, 12502, 12101, 12102, 12201, 12202, 12301, 12302, 12401,

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Cardiovascular Magnetic Resonance (CMR) Page 1 of 10 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Cardiovascular Magnetic Resonance (CMR) Professional Institutional

More information

DIGOXIN THERAPEUTIC DRUG ASSAY

DIGOXIN THERAPEUTIC DRUG ASSAY A18.84 Tuberculosis of heart E00.0 Congenital iodine-deficiency syndrome, neurological type E00.1 Congenital iodine-deficiency syndrome, myxedematous type E00.2 Congenital iodine-deficiency syndrome, mixed

More information

Common ICD-10 Diagnosis Codes for TEE/ References for 3D and Strain Imaging July 2017

Common ICD-10 Diagnosis Codes for TEE/ References for 3D and Strain Imaging July 2017 Common ICD-10 Diagnosis Codes for TEE/ References for 3D and Strain Imaging July 2017 The information provided here is for reference use only. It is based on a compilation of various payer and Medicare

More information

Title: Automatic External Defibrillators Division: Medical Management Department: Utilization Management

Title: Automatic External Defibrillators Division: Medical Management Department: Utilization Management Retired Date: Page 1 of 7 1. POLICY DESCRIPTION: Automatic External Defibrillators 2. RESPONSIBLE PARTIES: Medical Management Administration, Utilization Management, Integrated Care Management, Pharmacy,

More information

Automatic External Defibrillators

Automatic External Defibrillators Last Review Date: April 21, 2017 Number: MG.MM.DM.10dC3v4 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

Cardiology Documentation in an ICD-10 World

Cardiology Documentation in an ICD-10 World Cardiology Documentation in an ICD-10 World Providence Little Company of Mary Medical Center - Torrance July 10, 2015 Andrew H. Dombro, MD Internist/Hospitalist Regional Medical Director JA Thomas, a Nuance

More information

Detailed Order Request Checklists for Cardiology

Detailed Order Request Checklists for Cardiology Next Generation Solutions Detailed Order Request Checklists for Cardiology 8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 www.aimspecialtyhealth.com Appropriate.Safe.Affordable 2018

More information

Anatomy of the Heart and the. ICD-10 Codes

Anatomy of the Heart and the. ICD-10 Codes Anatomy of the Heart and the Diseases ICD-10 Codes Sharon J. Oliver CPC, CPMA, CPC-I All Rights Reserved 1 Anatomy of the Heart Pulmonary Tricuspid (AV) Valve Mitral Aortic Semilunar Valve Chordae Tendineae

More information

Clinical Policy: Holter Monitors Reference Number: CP.MP.113

Clinical Policy: Holter Monitors Reference Number: CP.MP.113 Clinical Policy: Reference Number: CP.MP.113 Effective Date: 05/18 Last Review Date: 04/18 Coding Implications Revision Log Description Ambulatory electrocardiogram (ECG) monitoring provides a view of

More information

Jurisdiction New Mexico. Retirement Date N/A

Jurisdiction New Mexico. Retirement Date N/A Local Coverage Determination (LCD): Chiropractic Services (L34816) Contractor Information Contractor Name Novitas Solutions, Inc. opens in new Contract Number 04212 Contract Type A and B MAC J - H LCD

More information

Clinical Policy: Cardiac Biomarker Testing for Acute Myocardial Infarction Reference Number: CP.MP.156

Clinical Policy: Cardiac Biomarker Testing for Acute Myocardial Infarction Reference Number: CP.MP.156 Clinical Policy: Reference Number: CP.MP.156 Effective Date: 12/17 Last Review Date: 12/17 See Important Reminder at the end of this policy for important regulatory and legal information. Description The

More information

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition

Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Hospice Alzheimer's Disease & Related Disorders (L31539)

Contractor Information. LCD Information. Local Coverage Determination (LCD): Hospice Alzheimer's Disease & Related Disorders (L31539) Local Coverage Determination (LCD): Hospice Alzheimer's Disease & Related Disorders (L31539) Contractor Information Contractor Name Palmetto GBA opens in new window LCD Information Document Information

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Cardiovascular Magnetic Resonance (CMR) Page 1 of 16 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Cardiovascular Magnetic Resonance (CMR) Professional Institutional

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Hospice - Neurological Conditions (L31537) Document Information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Hospice - Neurological Conditions (L31537) Document Information Local Coverage Determination (LCD): Hospice - Neurological Conditions (L31537) Contractor Information Contractor Name Palmetto GBA opens in new window LCD Information Document Information Contract Number

More information

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Session Guidelines This is a 15 minute webinar session for CNC physicians and staff CNC holds webinars on the 3 rd Wednesday of each month to address topics related to risk adjustment

More information

Cardiovascular Disease

Cardiovascular Disease Cardiovascular Disease Certification Examination Blueprints Blueprint for the Full-Day, Multiple-Choice Questions Component of the Exam: Purpose of the exam The exam is designed to evaluate the knowledge,

More information

2018 Diagnosis Coding Fact Sheet

2018 Diagnosis Coding Fact Sheet The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,

More information

Asthma J45.20 Mild, uncomplicated J45.21 Mild, with (acute) exacerbation J45.22 Mild, with status asthmaticus

Asthma J45.20 Mild, uncomplicated J45.21 Mild, with (acute) exacerbation J45.22 Mild, with status asthmaticus A Fib & Flutter I48.0 Paroxysmal atrial fibrillation I48.1 Persistent atrial fibrillation I48.2 Chronic atrial fibrillation I48.3 Typical atrial flutter Asthma J45.20 Mild, uncomplicated J45.21 Mild, with

More information

PROPOSED/DRAFT Local Coverage Determination (LCD): MolDX: Chromosome 1p/19q deletion analysis (DL36483)

PROPOSED/DRAFT Local Coverage Determination (LCD): MolDX: Chromosome 1p/19q deletion analysis (DL36483) moldx: Chromosome 1p/19q deletion analysis (DL36483) Page 1 of 8 PROPOSED/DRAFT Local Coverage Determination (LCD): MolDX: Chromosome 1p/19q deletion analysis (DL36483) Close Section Navigation

More information

CARDIOVASCULAR DISEASE Maintenance of Certification (MOC) Examination Blueprint

CARDIOVASCULAR DISEASE Maintenance of Certification (MOC) Examination Blueprint CARDIOVASCULAR DISEASE Maintenance of Certification (MOC) Examination Blueprint ABIM invites diplomates to help develop the Cardiovascular Disease MOC exam blueprint Based on feedback from physicians that

More information

Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures

Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures Supplemental Table 1. ICD-9 Codes for Diagnoses and Procedures ICD-9 Code Description Heart Failure 402.01 Malignant hypertensive heart disease with heart failure 402.11 Benign hypertensive heart disease

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Cardiovascular Nuclear Medicine (L33960) MP-055-MC-KY Medical Management Provider Notice Date: 05/01/2018 Issue Date: 06/01/2018

More information

Cardiothoracic and Cardiothoracic Surgery ICD-10-CM 2014: Reference Mapping Card

Cardiothoracic and Cardiothoracic Surgery ICD-10-CM 2014: Reference Mapping Card 2014: Reference Mapping Card 162.3 Malignant neoplasm upper lobe lung 162.5 Malignant neoplasm lower lobe lung 162.9 lung/bronchus 396.2 396.3 Mitral insufficiency, aortic stenosis Mitral aortic valve

More information

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A Local Coverage Determination (LCD): Circulating Tumor Cell Marker Assays (L35096) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information

More information

CLINICAL MEDICAL POLICY

CLINICAL MEDICAL POLICY Policy Name: Policy Number: Responsible Department(s): CLINICAL MEDICAL POLICY Cardiac Event Detection (L33952) MP-054-MC-KY Medical Management Provider Notice Date: 05/01/2018 Issue Date: 06/01/2018 Effective

More information

CHRONIC CAD DIAGNOSIS

CHRONIC CAD DIAGNOSIS CHRONIC CAD DIAGNOSIS Chest Pain Evaluation 1. Approach to diagnosis of CAD 2. Classification of chest pain 3. Pre-test likelihood CAD 4. Algorithm for chest pain evaluation in women 5. Indications for

More information

SAMPLE. Laboratory Services. An essential coding, billing, and reimbursement resource for laboratory and pathology services ICD-10

SAMPLE. Laboratory Services. An essential coding, billing, and reimbursement resource for laboratory and pathology services ICD-10 Coding and Payment Guide www.optumcoding.com Laboratory Services An essential coding, billing, and reimbursement resource for laboratory and pathology services 2017 ICD-10 A full suite of resources including

More information

Local Coverage Determination (LCD): RAST Type Tests ( L30524 )

Local Coverage Determination (LCD): RAST Type Tests ( L30524 ) Page 2 of 6 Local Coverage Determination (LCD): RAST Type Tests ( L30524 ) Contractor Information Contractor Name Novitas Solutions, Inc. Contract Number 12502 Contract Type A and B MAC LCD Information

More information

Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014

Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications of Coronary Angiography Dr. Shaheer K. George, M.D Faculty of Medicine, Mansoura University 2014 Indications for cardiac catheterization Before a decision to perform an invasive procedure such

More information

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders

C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders C1: Medical Standards for Safety Critical Workers with Cardiovascular Disorders GENERAL ISSUES REGARDING MEDICAL FITNESS-FOR-DUTY 1. These medical standards apply to Union Pacific Railroad (UPRR) employees

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acute coronary syndrome(s), anticoagulant therapy in, 706, 707 antiplatelet therapy in, 702 ß-blockers in, 703 cardiac biomarkers in,

More information

(For items 1-12, each question specifies mark one or mark all that apply.)

(For items 1-12, each question specifies mark one or mark all that apply.) Form 121 - Report of Cardiovascular Outcome Ver. 9.2 COMMENTS -Affix label here- Member ID: - - To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: - Central Case No.:

More information

AMBULATORY BLOOD PRESSURE MONITORING AND DEVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL

AMBULATORY BLOOD PRESSURE MONITORING AND DEVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL AMBULATORY BLOOD PRESSURE MONITORING AND DEVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL FEBRUARY 2018 CSHCN PROVIDER PROCEDURES MANUAL FEBRUARY 2018 AMBULATORY B LOOD PRESSURE MONITORING AND DEVICES Table

More information

HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM

HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM REVIEW DATE REVIEWER'S ID HEART AND SOUL STUDY OUTCOME EVENT - MORBIDITY REVIEW FORM : DISCHARGE DATE: RECORDS FROM: Hospitalization ER Please check all that may apply: Myocardial Infarction Pages 2, 3,

More information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Cardiac Rehabilitation (L34412) Document Information

Contractor Information. LCD Information. Local Coverage Determination (LCD): Cardiac Rehabilitation (L34412) Document Information Local Coverage Determination (LCD): Cardiac Rehabilitation (L34412) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information Contractor

More information

Process Measure: Screening for Adult Obstructive Sleep Apnea

Process Measure: Screening for Adult Obstructive Sleep Apnea Process Measure: Screening for Adult Obstructive Sleep Apnea Measure Description Description Type of Measure All patients aged 18 years and older at high risk for obstructive sleep apnea (OSA) with documentation

More information

Ambulatory Blood Pressure Monitoring

Ambulatory Blood Pressure Monitoring Ambulatory Blood Pressure Monitoring and Devices Chapter.1 Enrollment..................................................................... -2.2 Benefits, Limitations, and Authorization Requirements...........................

More information

Adult Echocardiography Examination Content Outline

Adult Echocardiography Examination Content Outline Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,

More information

A DAYS CARDIOVASCULAR UNIT GUIDE DUE WEDNESDAY 4/12

A DAYS CARDIOVASCULAR UNIT GUIDE DUE WEDNESDAY 4/12 A DAYS CARDIOVASCULAR UNIT GUIDE DUE WEDNESDAY 4/12 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY 3/20 - B 3/21 - A 3/22 - B 3/23 - A 3/24 - B 3/27 - A Dissection Ethics Debate 3/28 - B 3/29 - A Intro to Cardiovascular

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

b. To facilitate the management decision of a patient with an equivocal stress test.

b. To facilitate the management decision of a patient with an equivocal stress test. National Imaging Associates, Inc. Clinical guidelines EBCT HEART CT & HEART CT CONGENITAL CCTA CPT4 Codes: 75571 EBCT 75572, 75573 Heart CT & Heart CT Congenital 75574 - CCTA LCD ID Number: L33559 J K

More information

7. Echocardiography Appropriate Use Criteria (by Indication)

7. Echocardiography Appropriate Use Criteria (by Indication) Criteria for Echocardiography 1133 7. Echocardiography Criteria (by ) Table 1. TTE for General Evaluation of Cardiac Structure and Function Suspected Cardiac Etiology General With TTE 1. Symptoms or conditions

More information

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A

Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Jurisdiction Oregon. Retirement Date N/A Local Coverage Determination (LCD): MolDX: GeneSight Assay for Refractory Depression (L36324) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor

More information

Local Coverage Determination for Hospice Alzheimer's Disease &Related Disorders (L31539)

Local Coverage Determination for Hospice Alzheimer's Disease &Related Disorders (L31539) Page 1 of 6 Centers for Medicare & Medicaid Services Print Message: If you are experiencing issues printing this page, then please click Return to Previous Page and select the 'Need a PDF?' button. You

More information

Cardiac Event Monitors

Cardiac Event Monitors Last Review Date: July 14, 2017 Number: MG.MM.DM.18aCv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

National Imaging Associates, Inc. Clinical guidelines CARDIAC CATHETERIZATION -LEFT HEART CATHETERIZATION. Original Date: October 2015 Page 1 of 5

National Imaging Associates, Inc. Clinical guidelines CARDIAC CATHETERIZATION -LEFT HEART CATHETERIZATION. Original Date: October 2015 Page 1 of 5 National Imaging Associates, Inc. Clinical guidelines CARDIAC CATHETERIZATION -LEFT HEART CATHETERIZATION CPT Codes: 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461 LCD ID Number:

More information

Medical Review Guidelines Magnetic Resonance Angiography

Medical Review Guidelines Magnetic Resonance Angiography Medical Review Guidelines Magnetic Resonance Angiography Medical Guideline Number: MRG2001-05 Effective Date: 2/13/01 Revised Date: 2/14/2006 OHCA Reference OAC 317:30-5-24. Radiology. (f) Magnetic Resonance

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

MICHIGAN CORONARY CTA PRIOR-AUTHORIZATION INFORMATIONAL GUIDE

MICHIGAN CORONARY CTA PRIOR-AUTHORIZATION INFORMATIONAL GUIDE Payer BlueCross BlueShield Michigan Priority Health Health Alliance Plan of Michigan Policy Name Clinical Appropriateness Guidelines: Computerized Tomographic Angiography Coronary evicore Cardiac Imaging

More information

MolDX: Chromosome 1p/19q deletion analysis

MolDX: Chromosome 1p/19q deletion analysis MolDX: Chromosome 1p/19q deletion analysis CGS Administrators, LLC Jump to Section... Please Note: This is a Proposed LCD. Proposed LCDs are works in progress and not necessarily a reflection of the current

More information

Local Coverage Determination for Hospice - Liver Disease (L31536)

Local Coverage Determination for Hospice - Liver Disease (L31536) Page 1 of 5 Centers for Medicare & Medicaid Services Print Message: If you are experiencing issues printing this page, then please click Return to Previous Page and select the 'Need a PDF?' button. You

More information

ADVANCED CARDIOVASCULAR IMAGING. Medical Knowledge. Goals and Objectives PF EF MF LF Aspirational

ADVANCED CARDIOVASCULAR IMAGING. Medical Knowledge. Goals and Objectives PF EF MF LF Aspirational Medical Knowledge Goals and Objectives PF EF MF LF Aspirational Know the basic principles of magnetic resonance imaging (MRI) including the role of the magnetic fields and gradient coil systems, generation

More information

IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT JANUARY 24, 2012

IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT JANUARY 24, 2012 IHCP bulletin INDIANA HEALTH COVERAGE PROGRAMS BT201203 JANUARY 24, 2012 The IHCP to reimburse implantable cardioverter defibrillators separately from outpatient implantation Effective March 1, 2012, the

More information

ASE 2011 Appropriate Use Criteria for Echocardiography

ASE 2011 Appropriate Use Criteria for Echocardiography ASE 2011 Appropriate Use Criteria for Echocardiography Table 1. TTE for General Evaluation of Cardiac Structure and Function 1 2 Suspected Cardiac Etiology General With TTE Symptoms or conditions potentially

More information

Jurisdiction Georgia. Retirement Date N/A

Jurisdiction Georgia. Retirement Date N/A If you wish to save the PDF, please ensure that you change the file extension to.pdf (from.ashx). Local Coverage Determination (LCD): Surgery: Injections of the Spinal Canal (L32112) Contractor Information

More information

Outpatient Cardiac Rehabilitation

Outpatient Cardiac Rehabilitation Last Review Date: May 12, 2017 Number: MG.MM.ME.26bC3v2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

BUSINESS. Articles? Grades Midterm Review session

BUSINESS. Articles? Grades Midterm Review session BUSINESS Articles? Grades Midterm Review session REVIEW Cardiac cells Myogenic cells Properties of contractile cells CONDUCTION SYSTEM OF THE HEART Conduction pathway SA node (pacemaker) atrial depolarization

More information

Digoxin Therapeutic Drug Assay

Digoxin Therapeutic Drug Assay 190.24 - Digoxin Therapeutic Drug Assay A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin. HCPCS s (Alphanumeric,

More information

CORONARY ARTERY DISEASES

CORONARY ARTERY DISEASES CORONARY ARTERY DISEASES It has been estimated that over one third of the population eventually will die of CAD, and 20% will develop symptoms when younger than age 60 years. ANATOMY OF THE CORONARY ARTERIES

More information

Chapter 5 Section 1.1. Diagnostic Radiology (Diagnostic Imaging)

Chapter 5 Section 1.1. Diagnostic Radiology (Diagnostic Imaging) Radiology Chapter 5 Section 1.1 Issue Date: March 7, 1986 Authority: 32 CFR 199.4(a), (b)(2)(x), (c)(2)(viii), (e)(14) and 32 CFR 199.6(d)(2) 1.0 CPT 1 PROCEDURE CODES 70010-72292, 73000-76499, 77071-77084,

More information

Nuclear Cardiology Reimbursement. Todd Lamb, BS, AS, CNMT Clinical Operations Mgr Regions Hospital St. Paul, MN

Nuclear Cardiology Reimbursement. Todd Lamb, BS, AS, CNMT Clinical Operations Mgr Regions Hospital St. Paul, MN Nuclear Cardiology Reimbursement Todd Lamb, BS, AS, CNMT Clinical Operations Mgr Regions Hospital St. Paul, MN Slides are not to be reproduced without the permission of the author Slides are not to be

More information

Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center

Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center Presenter: Steven Brust, HCS-D, HCS-H Product Manager, Home Health Coding Center Pinpoint & properly assign the appropriate heart failure codes Left- vs. Right-sided Left ventricular failure (LVF) may

More information

Contractor Number Oversight Region Region IV

Contractor Number Oversight Region Region IV Local Coverage Determination (LCD) for Hospice - Renal Care (L31538) Contractor Information Contractor Name Palmetto GBA opens in new window Contractor Number 11004 Contractor Type HHH MAC LCD Information

More information

Local Coverage Determination (LCD) for Chiropractic Services (L34816) (Posted for Notice)

Local Coverage Determination (LCD) for Chiropractic Services (L34816) (Posted for Notice) Local Coverage Determination (LCD) for Chiropractic Services (L34816) (Posted for Notice) Print Contractor Information Contractor Name Novitas Solutions, Inc. Contractor Numbers 04911, 07101, 07102, 07201,

More information

CY2015 Hospital Outpatient: Endovascular Procedure APCs and Complexity Adjustments

CY2015 Hospital Outpatient: Endovascular Procedure APCs and Complexity Adjustments CY2015 Hospital Outpatient: Endovascular Procedure APCs Complexity Adjustments Comprehensive Ambulatory Payment Classifications (c-apcs) CMS finalized the implementation of 25 Comprehensive APC to further

More information

Contractor Information

Contractor Information FUTURE Local Coverage Determination (LCD): Cardiac Rehabilitation (L34412) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Please Note: Future Effective

More information

Prior Authorization Flexeril/Amrix (cyclobenzaprine) 2017

Prior Authorization Flexeril/Amrix (cyclobenzaprine) 2017 Drugs Requiring Prior Authorization Label Name GCN AMRIX ER 15 MG CAPSULE 97959 AMRIX ER 30 MG CAPSULE 97960 CYCLOBENZAPRINE 10 MG TABLET 18020 CYCLOBENZAPRINE 5 MG TABLET 12805 CYCLOBENZAPRINE 7.5 MG

More information

Listing Form: Heart or Cardiovascular Impairments. Medical Provider:

Listing Form: Heart or Cardiovascular Impairments. Medical Provider: Listing Form: Heart or Cardiovascular Impairments Medical Provider: Printed Name Signature Patient Name: Patient DOB: Patient SS#: Date: Dear Provider: Please indicate whether your patient s condition

More information

Cardiac Rehabilitation

Cardiac Rehabilitation Easy Choice Health Plan Harmony Health Plan of Illinois Missouri Care Ohana Health Plan, a plan offered by WellCare Health Insurance of Arizona OneCare (Care1st Health Plan Arizona, Inc.) Staywell of Florida

More information

Click here for Link to References: CMS Website HOPPS CY 2018 Final Rule. CMS Website HOPPS CY2018 Final Rule Updated November 2017.

Click here for Link to References: CMS Website HOPPS CY 2018 Final Rule. CMS Website HOPPS CY2018 Final Rule Updated November 2017. Final Compared to 3Q 2017 Rates Medicare Hospital Outpatient Prospective Payment System HOPPS () Nuclear Cardiology Procedures, Radiopharmaceuticals, and Drugs Click here for Link to References: CMS Website

More information

Chapter 4 Section 9.1

Chapter 4 Section 9.1 Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33361-33369, 33200-37186, 37195-37785, 92950-93272,

More information

CMS Limitations Guide MRA Radiology Services

CMS Limitations Guide MRA Radiology Services CMS Limitations Guide MRA Radiology Services Starting July 1, 2008, CMS has placed numerous medical necessity limits on tests and procedures. This reference guide provides you with all of the latest changes.

More information

HEART CONDITIONS IN SPORT

HEART CONDITIONS IN SPORT HEART CONDITIONS IN SPORT Dr. Anita Green CHD Risk Factors Smoking Hyperlipidaemia Hypertension Obesity Physical Inactivity Diabetes Risks are cumulative (multiplicative) Lifestyles predispose to RF One

More information

Chad Morsch B.S., ACSM CEP

Chad Morsch B.S., ACSM CEP What Is Cardiac Stress Testing? Chad Morsch B.S., ACSM CEP A Cardiac Stress Test is a test used to measure the heart's ability to respond to external stress in a controlled clinical environment. Cardiac

More information

There are 3 principle types of stress tests which do not involve the measurement of radiolabelled distribution within the body.

There are 3 principle types of stress tests which do not involve the measurement of radiolabelled distribution within the body. National Imaging Associates, Inc. Clinical guidelines MYOCARDIAL PERFUSION IMAGING HEART (CARDIAC) PET SCAN STRESS ECHOCARDIOGRAM (Non-emergent outpatient testing) CPT4 Codes: Refer to pages 11-12 LCD

More information

I have no financial disclosures

I have no financial disclosures Manpreet Singh MD I have no financial disclosures Exercise Treadmill Bicycle Functional capacity assessment Well validated prognostic value Ischemic assessment ECG changes ST segments Arrhythmias Hemodynamic

More information

WHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply.

WHI Form Report of Cardiovascular Outcome Ver (For items 1-11, each question specifies mark one or mark all that apply. WHI Form - Report of Cardiovascular Outcome Ver. 6. COMMENTS To be completed by Physician Adjudicator Date Completed: - - (M/D/Y) Adjudicator Code: OMB# 095-044 Exp: 4/06 -Affix label here- Clinical Center/ID:

More information

Exercise Test: Practice and Interpretation. Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine

Exercise Test: Practice and Interpretation. Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine Exercise Test: Practice and Interpretation Jidong Sung Division of Cardiology Samsung Medical Center Sungkyunkwan University School of Medicine 2 Aerobic capacity and survival Circulation 117:614, 2008

More information

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER:

ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM. General Instructions: ID NUMBER: FORM NAME: H F A DATE: 10/13/2017 VERSION: CONTACT YEAR NUMBER: ARIC HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM General Instructions: The Heart Failure Hospital Record Abstraction Form is completed for all heart failure-eligible cohort hospitalizations. Refer to

More information

Chapter 5 Section 1.1

Chapter 5 Section 1.1 Radiology Chapter 5 Section 1.1 Issue Date: March 7, 1986 Authority: 32 CFR 199.4(a), (b)(2)(x), (c)(2)(viii), (e)(14) and 32 CFR 199.6(d)(2) Copyright: CPT only 2006 American Medical Association (or such

More information

Chapter 4 Section 9.1

Chapter 4 Section 9.1 Surgery Chapter 4 Section 9.1 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2) and (c)(3) 1.0 CPT 1 PROCEDURE CODES 33010-33130, 33140, 33141, 33200-37186, 37195-37785, 92950-93272, 93303-93581,

More information

Crosswalk File of ICD9 Diagnosis Codes to Risk Group Assignment 1-Apr-15

Crosswalk File of ICD9 Diagnosis Codes to Risk Group Assignment 1-Apr-15 1 1500 MALIGNANT NEOPLASM OF CERVICAL ESOPHAGUS 1 1501 MALIGNANT NEOPLASM OF THORACIC ESOPHAGUS 1 1502 MALIGNANT NEOPLASM OF ABDOMINAL ESOPHAGUS 1 1503 MALIGNANT NEOPLASM OF UPPER THIRD OF ESOPHAGUS 1

More information