Medical Policy Unit: Part A and Part B Updates for December 2008

Breast Imaging: Mammography/Breast Echography (Sonography)/Breast MRI/Ductography (L26890) (R3):
effective 12/01/2008: Source of revision – External. ICD-9-CM code 611.71 was added to the “ICD-9-CM Codes that Support Medical Necessity” section of the LCD for CPT codes 77058, 77059 and 76645. This change is effective for services performed on or after 07/01/2008. A clarification was added to the “Indications” section for diagnostic mammography and breast sonography that the requirement for a treating physician’s order/referral is not applicable to hospital based radiologists for inpatient or outpatient services. No comment and notice periods required and none given.

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) L25907 (R3):
(effective 12/01/2008) Source of revision-External (reconsideration) ICD-9-CM Code 794.39, Nonspecific abnormal results of function studies; Cardiovascular; other, added to the list of ICD-9-CM Codes that Support Medical Necessity. This addition is effective 10/18/2008 although revision done 12/01/2008. No comment and notice periods required and none given.

Erythrocyte Sedimentation Rate (ESR) L25639 (R4):
(effective 12/01/2008): Source of revision - External (reconsideration) "The ICD-9-CM Codes that Support Medical Necessity" section of the policy is expanded with the addition of code 790.1. This addition is effective 10/01/2008 although revision is 12/01/2008.
Source of additional revision - External (reconsideration)"The ICD-9-CM Codes that Support Medical Necessity" section of the policy is expanded with the addition of ICD-9-CM codes 421.0-421.9 and 730.09-730.99 effective 12/01/2008. No comment and notice periods required and none given.

Esophagogastroduodenoscopy (EGD) (L26394)
(R3): effective 12/01/2008: Source of revision – External. ICD-9-CM codes 171.4, 171.5, 171.8, 171.9 and 239.0 were added to the “ICD-9-CM Codes that Support Medical Necessity” section of the LCD for CPT codes 43231, 43232, 43237, 43238, 43242 and 43259. A note was also added to this section regarding the usage of ICD-9-CM code 239.0. This change is effective for services performed on or after 04/01/2008.

Hyperbaric Oxygen Therapy (HBO) L25204
(R2): (effective 12/01/2008): Source of revision - External inquiry. ICD-9-CM code 440.23 will be added to the list of covered diagnoses. This addition is effective 11/01/2008 although revision is dated 12/01/2008. No comment and notice periods required and none given.

MOHS Micrographic Surgery L26371
(R2): (effective 12/01/2008) Source of revision - External (reconsideration) ICD-9-CM codes 233.30, 233.31, 233.32 and 233.39 to be added to the list of covered ICD-9-CM codes. This addition is effective 10/20/2008 although the revision is dated 12/01/2008. No comment and notice periods required and none given.

Psychological Services Coverage under the Incident to Provision for Physicians and Non-physicians (L26899) (*R2):
(effective 12/01/2008): Source of revision – Internal – the appendices for Delaware and New Jersey have been removed from the “Related Document” section of the LCD. This is in accordance with Section 911 of the Medicare Modernization Act of 2003. Effective on this date, claims processing for Delaware and New Jersey is performed by Highmark Medicare Services, the Part A/Part B MAC contractor for these states. Although revision R2 is effective 12/01/2008, the removal of the appendices for Delaware and New Jersey is effective 11/14/2008.