Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors: June 11, 2013, ICD-10: Upon Implementation of ICD-10
Implementation: ASC X12: November 10, 2014 Fluorodeoxyglucose (FDG) Positron Emission Tomography (PET) for Solid Tumors: May 19, 2014 – MAC Non-Shared System Edits; July 7, 2014 – CWF development/testing, FISS requirement development; October 6, 2014 – CWF, FISS, MCS Shared System Edits), ICD-10: Upon Implementation of ICD-10)
The LOCM is paid on a reasonable cost basis when rendered by a SNF to its Part B patients (in addition to payment for the radiology procedure) when it is used in one of the situations listed below.
The following HCPCS are used when billing for LOCM.
HCPCS Code Description (January 1. 1994, and later)
A4644 Supply of low osmolar contrast material (100-199 mgs of iodine);
A4645 Supply of low osmolar contrast material (200-299 mgs of iodine); or
A4646 Supply of low osmolar contrast material (300-399 mgs of iodine).
When billing for LOCM, SNFs use revenue code 0636. If the SNF charge for the radiology procedure includes a charge for contrast material, the SNF must adjust the charge for the radiology procedure to exclude any amount for the contrast material.
NOTE: LOCM is never billed with revenue code 0255 or as part of the radiology procedure.
The A/B MAC (A) will edit for the intrathecal procedure codes and the following codes to determine if payment for LOCM is to be made. If an intrathecal procedure code is not present, or one of the ICD codes is not present to indicate that a required medical condition is met, the A/B MAC (A) will deny payment for LOCM. In these instances, LOCM is not covered and should not be billed to Medicare.
When LOCM Is Separately Billable and Related Coding Requirements
• In all intrathecal injections. HCPCS codes that indicate intrathecal injections are:
70010 70015 72240 72255 72265 72270 72285 72295
One of these must be included on the claim; or
• In intravenous and intra-arterial injections only when certain medical conditions are present in an outpatient. The SNF must verify the existence of at least one of the following medical conditions, and report the applicable diagnosis code(s) either as a principal diagnosis code or other diagnosis codes on the claim:
o A history of previous adverse reaction to contrast material. The applicable ICD-9-CM codes are V14.8 and V14.9. The applicable ICD-10-CM codes are Z88.8 and Z88.9. The conditions which should not be considered adverse reactions are a sensation of heat, flushing, or a single episode of nausea or vomiting. If the adverse reaction occurs on that visit with the induction of contrast material, codes describing hives, urticaria, etc. should also be present, as well as a code describing the external cause of injury and poisoning, ICD-9-CM code E947.8. The applicable ICD-10 CM codes are: T50.8X5A Adverse effect of diagnostic agents, initial encounter, T50.8X5S Adverse effect of diagnostic agents, sequela , T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter, or T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela;
o A history or condition of asthma or allergy. The applicable ICD-9-CM codes are V07.1, V14.0 through V14.9, V15.0, 493.00, 493.01, 493.10, 493.11, 493.20, 493.21, 493.90, 493.91, 495.0, 495.1, 495.2, 495.3, 495.4, 495.5, 495.6, 495.7, 495.8, 495.9, 995.0, 995.1, 995.2, and 995.3. The applicable ICD-10-CM codes are in the table below:
J44.0 J44.9 J45.20 J45.22 J45.30 J45.32 J45.40
J45.42 J45.50 J45.52 J45.902 J45.909 J45.998 J67.0
J67.1 JJ67.2 J67.3 J67.4 J67.5 J67.6 J67.7
J67.8 J67.9 J96.00 J96.01 J96.02 J96.90 J96.91
J96.92 T36.0X5A T36.1X5A T36.2X5A T36.3X5A T36.4X5A T36.5X5A
T36. 6X5A T36.7X5A T36.8X5A T36.95XA T37.0X5A T37.1X5A T37.2X5A
T37.3X5A T37.8X5A T37.95XA T38.0X5A T38.1X5A T38.2X5A T38.3X5A
T38.4X5A T38.6X5A T38.7X5A T38.805A T38.815A T38.895A T38.905A
T38.995A T39.015A T39.095A T39.1X5A T39.2X5A T39.2X5A T39.315A
T39.395A T39.4X5A T39.8X5A T39.95XA T40.0X5A T40.1X5A T40.2X5A
T40.3X5A T40.4X5A T40.5X5A T40.605A T40.695A T40.7X5A T40.8X5A
T40.905A T40.995A T41.0X5A T41.1X5A T41.205A T41.295A T41.3X5A
T41.4X5A T41.X5A T41.5X5A T42.0X5A T42.1X5A T42.2X5A T42.3X5A
T42.4X5A T42.5X5A T42.6X5A 427.5XA 428.X5A T43.015A T43.025A
T43.1X5A T43.205A T43.215A T43.225A T43.295A T43.3X5A T43.4X5A
T43.505A T43.595A T43.605A T43.615A T43.625A T43.635A T43.695A
T43.8X5A T43.95XA T44.0X5A T44.1X5A T44.2X5A T44.3X5A T44.6X5A
T44.7X5A T44.8X5A T44.905A T44.995A T45.0X5A T45.1X5A T45.2X5A
T45.3X5A T45.4X5A T45.515A T45.525A T45.605A T45.615A T45.625A
T45.695A T45.7X5A T45.8X5A T45.95XA T46.0X5A T46.1X5A T46.2X5A
T46.3X5A T46.4X5A T46.5X5A T46.6X5A T46.7X5A T46.8X5A T46.905A
T46.995A T47.0X5A T47.1X5A T47.2X5A T47.3X5A T47.4X5A T47.5X5A
T47.6X5A T47.7X5A T47.8X5A T47.95XA T48.0X5A T48.1X5A T48.205A
T48.295A T48.3X5A T48.4X5A T48.5X5A T48.6X5A T48.905A T48.995A
T49.0X5A T49.1X5A T49.2X5A T49.3X5A T49.4X5A T49.5X5A T49.6X5A
T49.6X5A T47.X5A9 T49.8X5A T49.95XA T50.0X5A T50.1X5A T50.2X5A
T50.3X5A T50.4X5A T50.5X5A T50.6X5A T50.7X5A T50.8X5A T50.905a
T50.995A T50.A15A T50.A25A T50.A95A T50.B15A T50.B95A T50.Z15A
T50.Z95A T78.2XXA T78.3XXA T78.40XA T78.41XA T88.52XA T88.59XA
T88.6XXA Z51.89 Z88.0 Z88.1 Z88.2 Z88.3 Z88.4
Z88.5 Z88.6 Z88.7 Z88.8 Z88.9 Z91.010
o Generalized severe debilitation. The applicable ICD-9-CM codes are: 203.00, 203.01, all codes for diabetes mellitus, 518.81, 585, 586, 799.3, 799.4, and V46.1. The applicable ICD-10-CM codes are: J96.850, J96.00 through J96.02, J96.90 through J96.91, N18.1 through N19, R53.81, R64, and Z99.11 through Z99.12. Or
o Sickle Cell disease. The applicable ICD-9-CM codes are 282.4, 282.60, 282.61, 282.62, 282.63, and 282.69. The applicable ICD-10-CM codes are D56.0 through D56.3, D56.5 through D56.9, D57.00 through D57.1, D57.20, D57.411 through D57.419, and D57.811 through D57.819.