FIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION

Transcription

1 FIRST COAST SERVICE OPTIONS FLORIDA MEDICARE PART B LOCAL COVERAGE DETERMINATION CPT/HCPCS Codes Computed tomography, head or brain; without contrast material with contrast material(s) without contrast material, followed by contrast material(s) and further sections ICD-9 Codes that Support Medical Necessity (70450, 70460, 70470) Amebic brain abscess Tuberculous meningitis Tuberculoma of meninges Tuberculoma of brain Tuberculous abscess of brain Tuberculous encephalitis or myelitis Other specified tuberculosis of central nervous system Unspecified tuberculosis of central nervous system Meningococcal meningitis Meningococcal encephalitis Meningococcemia 042 Human immunodeficiency virus [HIV] disease Slow virus infection of central nervous system Meningitis due to enterovirus Other non-arthropod-borne viral diseases of central nervous system Postvaricella encephalitis Herpes zoster with meningitis Herpetic meningoencephalitis Herpes simplex meningitis Postmeasles encephalitis Encephalomyelitis due to rubella Mosquito-borne viral encephalitis Tick-borne viral encephalitis 064 Viral encephalitis transmitted by other and unspecified arthropods Mumps meningitis Mumps encephalitis Juvenile neurosyphilis Neurosyphilis Candidal meningitis Coccidioidal meningitis Infection by Histoplasma capsulatum, meningitis Infection by Histoplasma duboisii, meningitis

2 Histoplasmosis, unspecified, meningitis Meningoencephalitis due to toxoplasmosis Malignant neoplasm of trachea, bronchus, and lung Malignant neoplasm of bones of skull and face, except mandible Malignant neoplasm of brain Malignant neoplasm of cranial nerves Malignant neoplasm of cerebral meninges Malignant neoplasm of pituitary gland and craniopharyngeal duct Malignant neoplasm of pineal gland Malignant neoplasm of head, face, and neck Secondary and unspecified malignant neoplasm of lymph nodes of head, face, and neck Secondary malignant neoplasm of brain and spinal cord Secondary malignant neoplasm of other parts of nervous system Secondary malignant neoplasm of bone and bone marrow Malignant neoplasm without specification of site Lymphosarcoma involving lymph nodes of head, face, and neck Burkitt s tumor or lymphoma involving lymph nodes of head, face, and neck Hodgkin s granuloma involving lymph nodes of head, face, and neck Hodgkin s sarcoma involving lymph nodes of head, face, and neck Hodgkin s disease, lymphocytic-histiocytic predominance, involving lymph nodes of head, face, and neck Hodgkin s disease, nodular sclerosis, involving lymph nodes of head, face, and neck Hodgkin s disease, mixed cellularity, involving lymph nodes of head, face, and neck Hodgkin s disease, lymphocytic depletion, involving lymph nodes of the head, face, and neck Hodgkin s disease, unspecified, involving lymph nodes of the head, face, and neck Benign neoplasm of bones of skull and face Benign neoplasm of brain Benign neoplasm of cranial nerves Benign neoplasm of cerebral meninges Benign neoplasm of other specified sites of nervous system Benign neoplasm of pituitary gland and craniopharyngeal duct (pouch) Benign neoplasm of pineal gland Neoplasm of uncertain behavior of pituitary gland and craniopharyngeal duct Neoplasm of uncertain behavior of pineal gland Neoplasm of uncertain behavior of brain and spinal cord Neoplasm of uncertain behavior of meninges Neurofibromatosis Neoplasms of unspecified nature, brain Neoplasms of unspecified nature, endocrine glands and other parts of nervous system Diabetes with hyperosmolarity

3 Diabetes with other coma Disorders of the pituitary gland and its hypothalamic control Disorders of adrenal glands Dementias Delirium due to conditions classified elsewhere Subacute delirium Psychotic disorder with delusions in conditions classified elsewhere Psychotic disorder with hallucinations in conditions classified elsewhere Mood disorder in conditions classified elsewhere Persistent mental disorders due to conditions classified elsewhere Unspecified psychosis Specific nonpsychotic mental disorders due to brain damage Inflammatory diseases of the central nervous system Cerebral degenerations usually manifest in childhood Other cerebral degenerations Parkinson s disease Other extrapyramidal disease and abnormal movement disorders Spinocerebellar disease Other demyelinating diseases of central nervous system Hemiplegia and hemiparesis Infantile cerebral palsy Other paralytic syndromes Epilepsy Other conditions of brain Other and unspecified disorders of nervous system complications from surgically implanted device Other and unspecified disorders of meninges, not elsewhere classified Other specified disorders of nervous system Unspecified disorders of nervous system Trigeminal nerve disorders Facial nerve disorders Disorders of other cranial nerves Sudden visual loss Transient visual loss Diplopia Visual field defects Other specified visual disturbances Unspecified visual disturbance Paralytic ptosis Papilledema, unspecified Papilledema associated with increased intracranial pressure Disorders of optic chiasm associated with pituitary neoplasms and disorders Disorders of optic chiasm associated with other neoplasms Disorders of other visual pathways associated with neoplasms

4 Disorders of visual cortex associated with neoplasms Paralytic strabismus, third or oculomotor nerve palsy, partial Paralytic strabismus, third or oculomotor nerve palsy, total Paralytic strabismus, fourth or trochlear nerve palsy Paralytic strabismus, sixth or abducens nerve palsy External ophthalmoplegia Total ophthalmoplegia Vertigo of central origin Sudden hearing loss, unspecified Disorders of acoustic nerve Cerebrovascular disease Hepatic coma Cerebrovascular disorders in the puerperium Other acquired deformity of head Anencephalus and similar anomalies Other congenital anomalies of nervous system Other specified anomalies of nervous system Unspecified anomaly of brain, spinal cord, and nervous system Anomalies of cerebrovascular system Anomalies of skull and face bones Anomalies of other endocrine glands Situs inversus Conjoined twins Tuberous sclerosis Other hamartoses, not elsewhere classified Multiple congenital anomalies, so described Other specified anomalies Congenital anomaly, unspecified Disorders relating to short gestation and low birthweight Birth trauma, subdural and cerebral hemorrhage Epicranial subaponeurotic hemorrhage (massive) Other injuries to scalp Birth trauma, other injuries to skeleton (skull) Severe birth asphyxia Mild or moderate birth asphyxia Unspecified birth asphyxia in liveborn infant Other respiratory problems after birth Intraventricular hemorrhage Subarachnoid hemorrhage Convulsions in newborn Other and unspecified cerebral irritability in newborn Cerebral depression, coma, and other abnormal cerebral signs Alteration of consciousness Hallucinations

5 780.2 Syncope and collapse Convulsions Dizziness and giddiness Fever Other general symptoms Symptoms involving nervous and musculoskeletal systems Facial weakness Other symptoms involving nervous and musculoskeletal systems Headache Swelling, mass, or lump in head and neck Aphasia Other speech disturbance Other symbolic dysfunction Nonspecific abnormal findings on radiological and other examination of skull and head Nonspecific abnormal results of function studies, brain and central nervous system Fracture of skull Intracranial injury, excluding those with skull fracture Other open wound of scalp, without mention of complication Other open wound of scalp, complicated Other and unspecified open wound of head, complicated Injury to optic nerve and pathways Injury to other cranial nerve(s) Head injury, unspecified Mechanical complication of nervous system device, implant, and graft Nervous system complications V10.85 Personal history of malignant neoplasm of brain V10.86 Personal history of malignant neoplasm of other parts of nervous system V10.88 Personal history of malignant neoplasm of other endocrine glands and related structures *V45.2 Presence of cerebrospinal fluid drainage device V67.1 Follow-up examination, following radiotherapy V67.2 Follow-up examination, following chemotherapy Indications and Limitations of Coverage and/or Medical Necessity Tomography is the recording of internal body images at a pre-determined plane by x-ray. Computed tomography, or CAT scans, involve the measurement of the emergent x-ray beam by a scintillation counter. The electronic pulses are recorded on a magnetic disk and then processed by a minicomputer for reconstruction display of the body in cross-section on a cathode ray tube. Computed Tomography Scans Head (Procedure codes ) Florida Medicare will consider a computed tomography scan of the head to be medically reasonable and necessary when performed to establish a diagnosis or to monitor treatment for the following conditions:

6 Intracranial neoplasms, cerebral infarctions, ventricular displacement or enlargement, cortical atrophy, cerebral aneurysms, intracranial hemorrhage and hematoma, infection, edema, degenerative processes, cyst formation, multiple sclerosis, seizure disorders, head trauma, congenital abnormalities, presence of a foreign body, and radiation treatment planning. Coverage for headache should only be for the following situations: Patient suffering from headaches after a head injury. Head CAT scan is performed to rule out the possibility of a bleed. Patient suffering from headaches unusual in duration and not responding to medical therapy. Head CAT scan is performed to rule out the possibility of a tumor. Patient suffering from headaches characterized by sudden onset and severity. Head CAT scan is performed to rule out possibility of aneurysm and/or arteriovenous malformation.