Old J-13 LCD Name - Number

New LCD Number

How does the new LCD differ from the J-13 LCD?

Audiologic/Vestibular Function Tests -
L28190

L27390

There are significant changes to the “Indications” section. Please refer to the LCD. CPT code 92597 was removed and CPT codes 92629 and 92627 were added. The asterisk information regarding documentation requirements for initial and subsequent evaluations has been removed from the ICD-9-CM code section. The ICD-9-CM code lists describe conditions that may be medically necessary.

Chiropractic Services - L28144

L27350

CPT code 98943 (Chiropractic manipulative treatment (cmt); extraspinal, one or more regions) was removed from the policy.  ICD-9-CM codes 307.81 (tension headache), 333.83 (spasmodic torticollis), 781.92 (abnormal posture), and 784.0 (headache) were removed from the policy.  Some new ICD-9-CM codes were added to the policy including V58.9 (unspecified aftercare) to be used as a tertiary code documenting exacerbation of original condition.  Documentation requirements and utilization guidelines were updated.

Debridement Services – L28205

L27373

A limitation was added which states local/topical anesthesia or anesthesia administered by or incident to the provider is not separately payable. CPT codes 11055 and 11056 were added. The documentation requirement was removed for a pathology report when billing for CPT code 11044. A statement was added to the “Utilization Guidelines” section: if the patient has required more debridement services per wound than defined by the parameters listed, the medical record must include documentation reflecting neuropathic, vascular, metabolic, or other comorbid conditions.

Electrocardiogram (ECG or EKG) -L28189

L27427 -Electrocardiography

More than 500 additional codes have been added to the ICD-9-CM codes that support medical necessity. The CPT/HCPCS list has been expanded to include: 93040, 93041 and 93042.

Erectile Dysfunction, Evaluation and Treatment - L28127

L27371

The CPT/HCPCS codes have been expanded to include: 51784, 51785, 74445, 95869, 95870 and J0275.
The ICD-9-CM codes have been changed. Added codes are: 607.82 and 902.89. Deleted ICD-9-CM codes are: 867.8, 867.9, 902.87 and 902.9 

Flow Cytometry – L27386

L28123

CPT/HCPCS codes 86355, 86356, 86357, 86359, 86360, 86361 and 86367 have been added to the LCD.  The list of ICD-9 codes that support medical necessity has also been updated.   

Immunocytochemistry – L27348

L28143 -Immunohistochemistry

Bill type code 72X has been removed because it does not apply to this LCD.  Revenue Codes were updated. 

Laser Ablation of the Prostate – L27369

L28128

CPT/HCPCS code 52649 has been added to the LCD.  The list of ICD-9-codes that support medical necessity is unchanged. 

Lipid Profile/Cholesterol Testing – L27352

L28125

Bill types 12X and 14X have been added. CPT/HCPCs and ICD-9-CM codes remain unchanged.

Non-Invasive Vascular Diagnostic Studies - L28166 

L27355

The LCD has been reorganized with general indications and limitations and specific indications and limitations for each type of study.  ICD-9-CM codes may have been added or deleted for each type of study. The major change in this policy is the updated credentialing and accreditation requirements for personnel and facilities.  These requirements are already in place for New York Part B providers except those in Queens County and will take effect in other National Government Services jurisdictions two years from the effective date of the policy, November 15, 2010.

Ocular Photography – External - L28177 

L27383

The ICD-9-CM code list is similar to the existing LCD.  The list of ICD-9 Codes that DO NOT Support Medical Necessity was removed. 
The utilization guidelines have been updated as follows: 
“The frequency with which external ocular photography should be performed is based on the patient's underlying condition and the usual progression of that condition. This service should not be repeated if there has been no change in the patient’s conditions.
In some cases, it is expected that this service would be reasonable once yearly. However, in certain conditions, this test may be appropriate more frequently

Prostate Specific Antigen – L28146

L27357

The Indications section was expanded to add specific indications for Free PSA, and the value of PSA in differentiating benign from malignant disease. Information from the PSA National Coverage Determination was included in Limitations. Non-specific ICD-9-CM codes 793.7 and 794.9 were removed. Documentation requirements were expanded to include screening information and specific fPSA criteria.

Removal of Benign Skin Lesions – L28140

L27362

Several ICD-9-CM codes were added to the list of primary diagnoses in the section where a dual diagnosis is required. In addition, documentation requirements were added concerning excision of lesions that turn out to be malignant.

Serum Magnesium – L28136

L27375

Payable ICD-9-CM codes were revised with some deletions and numerous additions. Refer to the LCD for a complete list of covered ICD-9-CM codes. Utilization guidelines were added for specific conditions covered in the LCD.

Swallow Evaluation/Dysphagia – L28208

L27364 – Swallow Evaluation and Dysphagia Treatment

The “Indications and Limitations of Coverage and/or Medical Necessity” and “Documentation Requirements” sections were completely revised. Please refer to the LCD. CPT codes 70370, 70371 and 74230 were removed. CPT codes 92526 and 92700 were added. The ICD-9-CM codes in the “ICD-9-CM Codes that Support Medical Necessity” section were limited to dysphagia or laryngeal dysfunction. Therefore, many ICD-9-CM codes were removed. The parameter in the “Utilization Guidelines” section was removed.

Transesophageal Echocardiography (TEE) – L28162

L27381

Indications were added for cardiac/pericardiac masses and other pericardial disease, and diseases of the great vessels. CPT codes for Doppler echocardiography were removed from the LCD but coverage follows the same diagnosis criteria as their TEE base codes. The list of covered ICD-9-CM codes was expanded. Refer to the LCD for a complete list of covered ICD-9-CM codes.

Transthoracic Echocardiogarphy – L28169

(and Stress Echocardiography – L28139)

Transthoracic Echocardiography (TTE) - L27360

Stress Echocardiography information has been incorporated into the TTE LCD.
Indications criteria added for: Abnormalities of the Great Vessels, Arrhythmias and Palpitations, Syncope, and Pulmonary conditions. Limitations were expanded for screening situations. Criteria for Follow-up or Limited Studies, Doppler Color Flow Velocity Mapping, Limited Capability Ultrasound Scanners, Stress Echocardiography, and 3-Dimensional Echocardiography were added to the LCD. CPT codes 76377, 93350, OPPS codes C8921-C8924, C8928, and HCPCS codes for stress agents were added. The list of covered ICD-9-CM codes was updated and broken out by CPT codes for which they are covered.

Serum Magnesium – L703

L27375

Indications updated. Payable ICD-9-CM codes were revised with some deletions and some additions. Refer to LCD for complete list of current ICD-9-CM codes. Utilization guidelines were added for specific conditions covered in the LCD.

Swallow Evaluation – L686

L27364

The “Indications and Limitations of Coverage and/or Medical Necessity” and “Documentation Requirements” sections were completely revised. Please refer to the LCD. CPT codes 70370, 70371 and 74230 were removed. CPT codes 92526, 92613, 92615, 92617 and 92700 were added. The ICD-9-CM codes in the “ICD-9-CM Codes that Support Medical Necessity” section were limited to dysphagia or laryngeal dysfunction. Therefore, many ICD-9-CM codes were removed. The ICD-9-CM codes in the “ICD-9-CM Codes that DO NOT Support Medical Necessity” section were removed. The parameter in the “Utilization Guidelines” section was removed.