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Billing and Coding and Medical Policy Article Updates September/October 2022

Billing and Coding: Bevacizumab and biosimilars (A52370)

Based on Transmittal 11594, (CR 12885) October 2022 Update of the Hospital OPPS, HCPCS code C9142 has been added to the CPT/HCPCS Codes paragraph section and through out the article. Based on compendia review, ICD-10 code Z85.068 has been added to the Group 1 ICD-10-CM code list effective for dates of service on or after 10/1/2022.

Billing and Coding: Bortezomib (A52371)

Based on the annual ICD-10 code update, the descriptors for ICD-10 codes C84.40, C84.41, C84.42, C84.43, C84.44, C84.45, C84.46, C84.47, C84.48, C84.49 has been revised.

Billing and Coding: Cardiac Catheterization and Coronary Angiography (A52850)

Due to the annual ICD-10 updates for 2023, the following coding has been revised:

ICD-10 code I31.3 is deleted and replaced by codes I31.31 and I31.39 in groups 1 and 2;

ICD-10 code I34.8 is deleted and replaced by codes I34.81 and I34.89 in groups 1 and 2;

ICD-10 code I47.2 is deleted and replaced by codes I47.20, I47.21 and I47 29 in groups 1 and 2;

ICD-10 code I71.01 is deleted and replaced by codes I71.010, I71.011, I71.012, I71.019 in group 6;

ICD-10 code I71.1 is deleted and replaced by codes I71.11, I71.12, and I71.13 in group 6;

ICD-10 code I71.2 is deleted and replaced by codes I71.21, I71.22, and I71.23 in group 6;

ICD-10 code I71.3 is deleted and replaced by codes I71.31, I71.32, and I71.33 in group 6;

ICD-10 code I71.4 is deleted and replaced by codes I71.41, I71.42, and I71.43 in group 6;

ICD-10 code I71.5 is deleted and replaced by codes I71.51, and I71.52 in group 6;

ICD-10 code I71.6 is deleted and replaced by codes I71.61, and I71.62 in group 6;

ICD-10 code Q21.1 is deleted and replaced by codes Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19 in groups 1 and 4.

ICD-10 code Q21.2 is deleted and replaced by codes Q21.20, Q21.21, Q21.22 and Q21.23 in group 4.

Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (A56737)

Due to the annual ICD-10 updates for 2023:

ICD-10 code I31.3 is deleted and replaced by I31.31 and I31.39.

ICD-10 code I34.8 is deleted and replaced by I34.81 and I34.89.

ICD-10 code I71.01 is deleted and replaced by I71.010, I71.011, I71.012, and I71.019.

ICD-10 code I71.1 is deleted and replaced by I71.11, I71.12, and I71.13.

ICD-10 code I71.2 is deleted and replaced by I71.21, I71.22, and I71.23.

ICD-10 code Q21.1 is deleted and replaced by Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19.

ICD-10 code Q21.2 is deleted and replaced by Q21.20, Q21.21, Q21.22 and Q21.23.

Billing and Coding: Cardiovascular Nuclear Medicine (A56743)

Due to the annual ICD-10 code updates for 2023, ICD-10 code I47.2 is deleted and replaced by I47.20, I47.21 and I47.29 in Group 1.

Billing and Coding: Computed Tomographic (CT) Colonography for Diagnostic Uses (A57026)

Due to the annual ICD-10 code updates, Q85.8 has been deleted from ICD-10 Codes that support Medical Necessity Group 2 and the following codes have been added: Q85.81, Q85.82, Q85.83 and Q85.89.

Billing and Coding: Eculizumab (A54548)

Based on the annual ICD-10 code update, ICD-10 code D59.3 has been deleted and replaced by D59.31, D59.32 and D59.39.

Billing and Coding: Filgrastim, Pegfilgrastim, Tbo-filgrastim and biosimilars (A52408)

Based on the annual ICD-10 code update, the descriptor for ICD-10 code C94.6 was changed in Group 4. Based on Transmittal 11594, (CR 12885) October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS), HCPCS code Q5125 has been added to the CPT/HCPCS Codes paragraph section of the article.

Billing and Coding: Frequency of Hemodialysis (A55672)

Due to the annual ICD-10 updates for 2023, ICD-10 code E87.2 is being deleted and is replaced by codes E87.20, E87.21, E87.22, E87.29

Billing and Coding: Genomic Sequence Analysis Panels in the Treatment of Hematolymphoid Diseases (A56793)

Due to the annual ICD-10-CM update, C94.6 descriptor was changed in Group 2- "ICD-10-CM Codes that Support Medical Necessity" section.

Billing and Coding: Implantable Automatic Defibrillators (A56326)

Based on Transmittal 11440 (CR 12705)–Annual (2023) Update of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), ICD-10 code I47.2 has been deleted from the Group 1 codes and ICD-10 codes I47.21 and I47.29 have been added. ICD-10 code I47.2 has been removed and ICD-10 codes I47.21 and I47.29 have been added to the following sentence under Item B1 in the Article Text section: ICD-10-CM codes which describe the above: I46.2, I46.9, I47.21, I47.29, I49.01, I49.02, I49.3, I49.9, I5A, Z45.02 or Z86.74.

Billing and Coding: Infliximab and biosimilars (A52423)

Correction: ICD-10 code M06.1 is included in the Group 2 code range M06.00 – M06.39 so it has been removed from the Group 3 list.

Billing and Coding: Intravenous Immune Globulin (IVIG) (A52446)

Based on the annual ICD-10 code update, ICD-10 code D68.0 has been deleted and replaced with ICD-10 codes D68.01, D68.020, D68.021, D68.022, D68.023, D68.03, D68.04 and D68.09. ICD-10 code I47.2 has been deleted and replaced with ICD-10 codes I47.21 and I47.29.

Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (A52453)

Based on the annual ICD-10 code update, ICD-10 codes N80.0, N80.1, N80.2, N80.3, N80.4 and N80.5 have been deleted and replaced with N80.01, N80.02, N80.03, N80.101, N80.102, N80.103, N80.109, N80.111, N80.112, N80.113, N80.121, N80.122, N80.123, N80.201, N80.202, N80.203, N80.211, N80.212, N80.213, N80.221, N80.222, N80.223, N80.311, N8.0312, N80.319, N80.321, N80.322, N80.329, N80.331, N80.332, N80.333, N80.341, N80.342, N80.343, N80.351, N80.352, N80.353, N80.361, N80.362, N80.363, N80.371, N80.372, N80.373, N80.381, N80.382, N80.383, N80.391, N80.392, N80.399, N80.3A1, N80.3A2, N80.3A3, N80.3B1, N80.3B2, N80.3B3, N80.3C1, N80.3C2, N803.C3, N80.41, N80.42, N80.511, N80.512, N80.519, N80.521, N8.0522, N80.529, N80.531, N80.532, N80.539, N80.541, N80.542, N80.549, N80.551, N80.552, N80.559, N80.561, N80.562, N80.569, N80.A0, N80.A1, N80.A2, N80.A41, N80.A42, N80.A43, N80.A51, N80.A52, N80.A53, N80.A61, N80.A62, N80.A63, N80.B1, N80.B2, N80.B31, N80.B32, N80.B39, N80.B4, N80.B5, N80.B6, N80.C10, N80.C11, N80.C19, N80.C2, N80.C3, N80.C4, N80.C9, N80.D1, N80.D2, N80.D3, N80.D4, N80.D5, N80.D6, and N80.D9 in Group 1 and 4 of the ICD-10 code lists. ICD-10 code N80.0 has been deleted from the Group 2 ICD-10 code list and has been replaced with N80.01, N80.02, N80.03.

Billing and Coding: Magnetic Resonance Angiography (MRA) (A56747)

Due to the annual ICD-10 code updates for 2023:

For Group 4, MRA of the chest, ICD-10 code I71.01 is deleted and replaced by I71.010, I71.011, and I71.012; ICD-10 code I71.2 is deleted and replaced by I71.21, I71.22, and I71.23; and ICD-10 code I71.6 is deleted and replaced by I71.61 and I71.62.

For Group 3, MRA of the abdomen and pelvis, ICD-10 code I71.4 is deleted and replaced by I71.41, I71.42 and I71.43; and ICD-10 code I71.6 is deleted and replaced by I71.61 and I71.62.

Billing and Coding: Molecular Pathology Procedures (A56199)

Due to the annual ICD-10-CM code update, the following codes had descriptor changes occur in the ICD-10-CM section that supports Medical Necessity.: C94.6 descriptor was changed in Group 14; C94.6 descriptor was changed in Group 29; C94.6 descriptor was changed in Group 31; C94.6 descriptor was changed in Group 32.

Billing and Coding: Nerve Conduction Studies and Electromyography (A57668)

Due to the annual ICD-10 updates for 2023, ICD-10 code G93.3 is being deleted and replaced by codes G93.31 and G93.39.

Billing and Coding: Non-Invasive Vascular Studies (A56758)

Due to annual ICD-10 updates for 2023, ICD-10 the following ICD-10 codes were deleted from Group 5: I71.01, I71.1, I71.2, I71.3, I71.4, I71.5, I71.6.

The following ICD-10 codes were added to Group 5: I71.010, I71.011, I71.012, I71.019, I71.02, I71.03, I71.10, I71.11, I71.12, I71.13, I71.20, I71.21, I71.22, I71.23, I71.30, I71.31, I71.32, I71.33, I71.40, I71.41, I71.42, I71.43, I71.50, I71.51, I71.52, I71.60, I71.61, I71.62, I77.82, J95.87.

Billing and Coding: Nonvascular Extremity Ultrasound (A56787)

ICD-10 codes C77.3 and D36.0 have been added as payable for CPT code 76882.

Billing and Coding: Ophthalmology: Posterior Segment Imaging (Extended Ophthalmoscopy and Fundus Photography) (A56726)

Due to the annual ICD-10 updates for 2023, ICD-10 code Q85.8 was deleted and replaced by Q85.81, Q85.82, Q85.83 and Q85.89.

Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane™) (A52450)

Based on the annual ICD-10 code update, the descriptors for ICD-10 codes C84.40, C84.41, C84.42, C84.43, C84.44, C84.45, C84.46, C84.47, C84.48, C84.49 has been revised in the Group 2 list.

Billing and Coding: Peripheral Nerve Blocks (A57452)

Due to the annual ICD-10 code updates, the descriptor has been changed for the following codes in Group 1 and Group 2 in the "ICD-10 codes that support medical necessity" section: C84.40 through C84.49.

Billing and Coding: Psychiatric Inpatient Hospitalization (A56865)

Due to the annual ICD-10 updates for 2023, ICD-10 code description was changed: F01.50.

The following ICD-10 codes were deleted from the Covered ICD-10 codes Group 1: F01.51, F02.81.

The following ICD-10 codes were added to the Covered ICD-10 codes Group 1: F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4.

Billing and Coding: Psychiatry and Psychology Services (A56937)

Due to the annual ICD-10 updates for 2023, ICD-10 code descriptions were changed: F01.50, F02.80, F03.90, G31.09, G31.83, and G31.84.

The following ICD-10 codes were deleted from Group 1: F01.51, F02.81, and F03.91.

The following ICD-10 codes were added to Group 1: F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F06.70, F06.71, F10.90, F10.91, F11.91, F12.91, F13.91, F14.91, F15.91, F16.91, F18.91, F19.91.

Billing and Coding: Ranibizumab, Aflibercept and Brolucizumab-dbll and Faricimab-svoa (A54251)

Based on Transmittal 11594, (CR 12885) October 2022 Update of the Hospital Outpatient Prospective Payment System (OPPS), HCPCS code J2777 has been added to the CPT/HCPCS Codes paragraph section of the article. Ranibizumab-eqrn (CIMERLI™) (J3490, J3590, C9399) has been added to the article effective 08/02/2022.

Billing and Coding: Rituximab, biosimilars and Rituximab and hyaluronidase human (Rituxan Hycela™)(A52452)

Based on the annual ICD-10 code update, the descriptors have changed for ICD-10 codes C84.49 and C94.6 in Group 1. Based on compendia review, ICD-10 codes T86.41, and Z94.89 have been added to Group 1 effective for dates of service on or after 10/01/2022.

Billing and Coding: Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI) (A56537)

Due to the annual ICD-10-CM update, the following codes have been added to the "ICD-10-CM Codes that Support Medical Necessity" section-Group 2- to be used in conjunction with CPT code 92133 (posterior segment-optic nerve) only, effective 10/1/2022:

S060XAA, S060XAD, S060XAS, S061XAA, S061XAD, S061XAS, S062XAA, S062XAD, S062XAS, S0630AA, S0630AD, S0630AS, S0631AA, S0631AD, S0631AS, S0632AA, S0632AD, S0632AS, S0633AA, S0633AD, S0633AS, S0634AA, S0634AD, S0634AS, S0635AA, S0635AD, S0635AS, S0636AA, S0636AD, S0636AS, S0637AA, S0637AD, S0637AS, S0638AA, S0638AD, S0638AS, S064XAA, S064XAD, S064XAS, S065XAA, S065XAD, S065XAS, S066XAA, S066XAD, S066XAS, S0681AA, S0681AD, S0681AS, S0682AA, S0682AD, S0682AS, S0689AA, S0689AD, S0689AS, S068A0A, S068A0D, S068A0S, S068A1A, S068A1D, S068A1S, S068A2A, S068A2D, S068A2S, S068A3A, S068A3D, S068A3S, S068A4A, S068A4D, S068A4S, S068A5A, S068A5D, S068A5S, S068A6A, S068A6D, S068A6S, S068A7A, S068A8A, S068A9A, S068A9D, S068A9S, S068AAA, S068AAD, S068AAS, S069XAA, S069XAD, S069XAS

Billing and Coding: Stem Cell Transplantation (A52879)

Based on the annual ICD-10 code update, the descriptor was changed for ICD-10 codes C84.41 through C84.49 in Groups 1 and 2.

Billing and Coding: Transesophageal Echocardiography (TEE) (A52868)

Due to the annual ICD-10 updates for 2023, these coding changes have been made:

For group 1, ICD-10 code I34.8 is deleted and replaced by I34.81 and I34.89; ICD-10 code I71.01 is deleted and replaced by I71.010, I71.011, I71.012, and I71.019; ICD-10 code I71.1 is deleted and replaced by I71.10, I71.11, I71.12, and I71.13; ICD-10 code I71.2 is deleted and replaced by I71.20, I71.21, I71.22 and I71.23; ICD-10 code I71.5 is deleted and replaced by I71.50, I71. 51, and I71.52; ICD-10 code I71.6 is deleted and replaced by I71.60, I71.61, and I71.62; ICD-10 code Q21.1 is deleted and replaced by Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19.

For groups 2 and 3, ICD-10 code Q21.1 is deleted and replaced by Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19; ICD-10 code Q21.2 is deleted and replaced by Q21.20, Q21.21, Q21.22 and Q21.23.

For group 3, ICD-10 code I34.8 is deleted and replaced by I34.81 and I34.89.

Billing and Coding: Transthoracic Echocardiography (TTE) (A56781)

Due to the annual ICD-10 updates for 2023, these coding changes have been made:

For group 1, ICD-10 code I31.3 is deleted and replaced by I31.31 and I31.39;

ICD-10 code I34.8 is deleted and replaced by I34.81 and I34.89;

ICD-10 code I47.2 is deleted and replaced by I47.20, I47.21 and I47.29;

ICD-10 code I71.01 is deleted and replaced by I71.010, I71.011, I71.012, and I71.019;

ICD-10 code I71.1 is deleted and replaced by I71.10, I71.11, I71.12, and I71.13;

ICD-10 code I71.2 is deleted and replaced by I71.20, I71.21, I71.22 and I71.23;

ICD-10 code I71.5 is deleted and replaced by I71.50, I71. 51, and I71.52;

ICD-10 code I71.6 is deleted and replaced by I71.60, I71.61, and I71.62;

ICD-10 code Q21.1 is deleted and replaced by Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19; 

ICD-10 code Q21.2 is deleted and replaced by Q21.20, Q21.21, Q21.22 and Q21.23;

ICD-10 code I77.82 was added.

For group 2, ICD-10 code P28.3 is deleted and replaced by P28.30, P28.31, P28.32, P28.33 and P28.39;

ICD-10 code P28.4 is deleted and replaced by P28.40, P28.41, P28.42, P28.43 and P28.49;

ICD-10 code Q21.1 is deleted and replaced by Q21.10, Q21.11, Q21.12, Q21.13, Q21.14, Q21.15, Q21.16 and Q21.19;

ICD-10 code Q21.2 is deleted and replaced by Q21.20, Q21.21, Q21.22 and Q21.23.

For groups 3 and 4, ICD-10 code I34.8 is deleted and replaced by I34.81 and I34.89.

Billing and Coding: Urine Drug Testing (A56761)

Due to annual ICD-10 updates for 2023, ICD-10 the following ICD-10 codes were deleted from Group 1: E87.2, I47.2, Z91.19.

The following ICD codes were added to Group 1: E87.20, E87.21, E87.22, E87.29, I47.20, I47.21, I47.29, Z91.190, Z91.198, Z91.199, Z91.A10, Z91.A18, Z91.A20, Z91.A28, Z91.A3, Z91.A4, Z91.A5, Z91.A9.

Health and Behavior Assessment/Intervention – Medical Policy Article (A52434)

Due to the annual ICD-10 updates for 2023, ICD-10 code descriptions were changed: F01.50, F02.80, F03.90, G31.09, G31.83, G31.84.

The following ICD-10 codes were deleted from the ICD-10 Codes that DO NOT Support Medical Necessity, Group 1: F01.51, F02.81, F03.91, F43.8.

The following ICD-10 codes were added to the ICD-10 Codes that DO NOT Support Medical Necessity, Group 1: F01.511, F01.518, F01.52, F01.53, F01.54, F01.A0, F01.A11, F01.A18, F01.A2, F01.A3, F01.A4, F01.B0, F01.B11, F01.B18, F01.B2, F01.B3, F01.B4, F01.C0, F01.C11, F01.C18, F01.C2, F01.C3, F01.C4, F02.811, F02.818, F02.82, F02.83, F02.84, F02.A0, F02.A11, F02.A18, F02.A2, F02.A3, F02.A4, F02.B0, F02.B11, F02.B18, F02.B2, F02.B3, F02.B4, F02.C0, F02.C11, F02.C18, F02.C2, F02.C3, F02.C4, F03.911, F03.918, F03.92, F03.93, F03.94, F03.A0, F03.A11, F03.A18, F03.A2, F03.A3, F03.A4, F03.B0, F03.B11, F03.B18, F03.B2, F03.B3, F03.B4, F03.C0, F03.C11, F03.C18, F03.C2, F03.C3, F03.C4, F06.70, F06.71, F10.90, F10.91, F11.91, F12.91, F13.91, F14.91, F15.91, F16.91, F18.91, F19.91, F43.81, F43.89.

Self-Administered Drug Exclusion List: Medical Policy Article (A53021/A53022)

The article has been updated to add: Tralokinumab-Idrm (Adbry™) effective for dates of service on or after 11/1/2022.

Posted 9/26/2022