This is part of a series of coding-specific articles for U.S.-based radiology practitioners that is appearing on AuntMinnie.com courtesy of Coding Strategies Incorporated. If you'd like to offer your comments about the material, please e-mail [email protected].
By Melody W. Mulaik
Coding Strategies Incorporated
PET coverage changes
The Centers for Medicare and Medicaid Services (CMS) has revised §50-36 of the Coverage Issues Manual (CIM) for PET scan services performed on or after October 1, 2002, for breast cancer and myocardial viability. New and revised Healthcare Common Procedure Coding System (HCPCS) codes are provided for proper claim submission.
Coverage for breast cancer
Effective for dates of service on or after October 1, 2002, Medicare will cover FDG-PET as an adjunct to other imaging modalities for staging and restaging for locoregional recurrence or metastasis. Monitoring treatment of a locally advanced breast cancer tumor and metastatic breast cancer when a change in therapy is contemplated is also covered as an adjunct to other imaging modalities. The baseline PET study for monitoring should be done under the code for staging or restaging.
Effective for dates of services on or after October 1, 2002, Medicare continues to have a national non-coverage determination for initial diagnosis of breast cancer and initial staging of axillary lymph nodes.
New codes
G0252 -- PET imaging for breast cancer, full- and partial-ring PET scanners only, for initial diagnosis of breast cancer or surgical planning for breast cancer (for example, initial staging of axillary lymph nodes), not covered by Medicare.
G0253 -- PET imaging for breast cancer, full- and partial-ring PET scanners only, staging or restaging of local regional recurrence or distant metastases, such as staging or restaging after or prior to course of treatment.
G0254 -- PET imaging for breast cancer, full- and partial-ring PET scanners only, evaluation of response to treatment, performed during course of treatment.
Coverage for myocardial viability
FDG-PET is covered for the determination of myocardial viability following an inconclusive SPECT test from July 1, 2001 through September 30, 2002. Only full-ring scanners are covered as the scanning medium for this service from July 1, 2001 through December 31, 2001. However, as of January 1, 2002, full- and partial-ring scanners are covered for myocardial viability following an inconclusive SPECT.
Beginning October 1, 2002, Medicare will cover FDG-PET for the determination of myocardial viability as a primary or initial diagnostic study prior to revascularization, and will continue to cover FDG-PET when used as a follow-up to an inconclusive SPECT. However, if a patient received an FDG-PET study with inconclusive results, a follow-up SPECT is not covered. FDA-cleared full- and partial-ring PET scanners are covered.
Codes for myocardial viability PET scans performed on or after October 1, 2002
G0230 -- PET imaging; metabolic assessment for myocardial viability following inconclusive SPECT study, full- and partial-ring PET scanners only should continue to be billed following an inconclusive SPECT.
78459 -- Myocardial imaging, PET, and metabolic evaluation should be used for determination of myocardial viability as a primary or initial diagnostic study prior to revascularization.
Watch for local medical review policies from your carrier regarding medical necessity requirements and utilization of all of the PET scan codes.
|
2003 diagnosis code update |
|
|
|
|
|
The May 9, 2001 Federal Register includes these changes to ICD-9-CM effective October 1, 2002 |
|
|
|
|
|
New codes |
|
|
Code |
Description |
|
040.82 |
Toxic shock syndrome |
|
066.4 |
West Nile fever |
|
277.02 |
Cystic fibrosis with pulmonary manifestations |
|
277.03 |
Cystic fibrosis with gastrointestinal manifestations |
|
277.09 |
Cystic fibrosis with other manifestations |
|
357.81 |
Chronic inflammatory myelinating polyneuritis |
|
357.82 |
Critical illness polyneuropathy |
|
357.89 |
Other inflammatory and toxic neuropathy |
|
359.81 |
Critical illness myopathy |
|
359.89 |
Other myopathies |
|
365.83 |
Aqueous misdirection |
|
414.06 |
Coronary atherosclerosis of coronary artery of transplanted heart |
|
414.12 |
Dissection of coronary artery |
|
428.20 |
Unspecified systolic heart failure |
|
428.21 |
Acute systolic heart failure |
|
428.22 |
Chronic systolic heart failure |
|
428.23 |
Acute on chronic systolic heart failure |
|
428.30 |
Unspecified diastolic heart failure |
|
428.31 |
Acute diastolic heart failure |
|
428.32 |
Chronic diastolic heart failure |
|
428.33 |
Acute on chronic diastolic heart failure |
|
428.40 |
Unspecified combined systolic and diastolic heart failure |
|
428.41 |
Acute combined systolic and diastolic heart failure |
|
428.42 |
Chronic combined systolic and diastolic heart failure |
|
428.43 |
Acute on chronic combined systolic and diastolic heart failure |
|
438.6 |
Alterations of sensations |
|
438.7 |
Disturbances of vision |
|
438.83 |
Facial weakness |
|
438.84 |
Ataxia |
|
438.85 |
Vertigo |
|
443.21 |
Dissection of carotid artery |
|
443.22 |
Dissection of iliac artery |
|
443.23 |
Dissection of renal artery |
|
443.24 |
Dissection of vertebral artery |
|
443.29 |
Dissection of other artery |
|
445.01 |
Atheroembolism, upper extremity |
|
445.02 |
Atheroembolism, lower extremity |
|
445.81 |
Atheroembolism, kidney |
|
445.89 |
Atheroembolism, other site |
|
454.8 |
Varicose veins of the lower extremities, with other complications |
|
459.10 |
Postphlebetic syndrome without complications |
|
459.11 |
Postphlebetic syndrome with ulcer |
|
459.12 |
Postphlebetic syndrome with inflammation |
|
459.13 |
Postphlebetic syndrome with ulcer and inflammation |
|
459.19 |
Postphlebetic syndrome with other complication |
|
459.30 |
Chronic venous hypertension without complications |
|
459.31 |
Chronic venous hypertension with ulcer |
|
459.32 |
Chronic venous hypertension with inflammation |
|
459.33 |
Chronic venous hypertension with ulcer and inflammation |
|
459.39 |
Chronic venous hypertension with other complication |
|
537.84 |
Dieulafoy lesion (hemorrhagic) of stomach and duodenum |
|
569.86 |
Dieulafoy lesion (hemorrhagic) of intestine |
|
633.00 |
Abdominal pregnancy without intrauterine pregnancy |
|
633.01 |
Abdominal pregnancy with intrauterine pregnancy |
|
633.10 |
Tubal pregnancy without intrauterine pregnancy |
|
633.11 |
Tubal pregnancy with intrauterine pregnancy |
|
633.20 |
Ovarian pregnancy without intrauterine pregnancy |
|
633.21 |
Ovarian pregnancy with intrauterine pregnancy |
|
633.80 |
Other ectopic pregnancy without intrauterine pregnancy |
|
633.81 |
Other ectopic pregnancy with intrauterine pregnancy |
|
633.90 |
Unspecified ectopic pregnancy without intrauterine pregnancy |
|
633.91 |
Unspecified ectopic pregnancy with intrauterine pregnancy |
|
747.83 |
Persistent fetal circulation |
|
765.20 |
Unspecified weeks of gestation |
|
765.21 |
Less than 24 completed weeks of gestation |
|
765.22 |
24 completed weeks of gestation |
|
765.23 |
25-26 completed weeks of gestation |
|
765.24 |
27-28 completed weeks of gestation |
|
765.25 |
29-30 completed weeks of gestation |
|
765.26 |
31-32 completed weeks of gestation |
|
765.27 |
33-34 completed weeks of gestation |
|
765.28 |
35-36 completed weeks of gestation |
|
765.29 |
37 or more completed weeks of gestation |
|
770.81 |
Primary apnea of newborn |
|
770.82 |
Other apnea of newborn |
|
770.83 |
Cyanotic attacks of newborn |
|
770.84 |
Respiratory failure of newborn |
|
770.89 |
Other respiratory problems after birth |
|
771.81 |
Septicemia [sepsis] of newborn |
|
771.82 |
Urinary tract infection of newborn |
|
771.83 |
Bacteremia of newborn |
|
771.89 |
Other infections specific to the perinatal period |
|
779.81 |
Neonatal bradycardia |
|
779.82 |
Neonatal tachycardia |
|
779.89 |
Other specified conditions originating in the perinatal period |
|
780.91 |
Fussy infant (baby) |
|
780.92 |
Excessive crying of infant (baby) |
|
780.99 |
Other general symptoms |
|
781.93 |
Ocular torticollis |
|
795.00 |
Nonspecific abnormal Papanicolaou smear of cervix, unspecified |
|
795.01 |
Atypical squamous cell changes of undetermined significance favor benign (ASCUS favor benign) |
|
795.02 |
Atypical squamous cell changes of undetermined significance favor dysplasia (ASCUS favor dysplasia) |
|
795.09 |
Other nonspecific abnormal Papanicolaou smear of cervix |
|
795.31 |
Nonspecific positive findings of anthrax |
|
795.39 |
Other nonspecific positive culture findings |
|
813.45 |
Torus fracture of radius |
|
823.40 |
Torus facture, tibia alone |
|
823.41 |
Torus fracture, fibula alone |
|
823.42 |
Torus fracture, fibular with tibia |
|
995.90 |
Systemic inflammatory response syndrome, unspecified |
|
995.91 |
Systemic inflammatory response syndrome due to infectious process without organ dysfunction |
|
995.92 |
Systemic inflammatory response syndrome due to infectious process with organ dysfunction |
|
995.93 |
Systemic inflammatory response syndrome due to non-infectious process without organ dysfunction |
|
995.94 |
Systemic inflammatory response syndrome due to non-infectious process with organ dysfunction |
|
998.31 |
Disruption of internal operation wound |
|
998.32 |
Disruption of external operation wound |
|
V01.81 |
Contact with or exposure to communicable diseases, anthrax |
|
V01.89 |
Contact with or exposure to communicable diseases, other communicable diseases |
|
V13.21 |
Personal history of pre-term labor |
|
V13.29 |
Personal history of other genital system and obstetric disorders |
|
V23.41 |
Pregnancy with history of pre-term labor |
|
V23.49 |
Pregnancy with other poor obstetric history |
|
V46.2 |
Other dependence on machines, supplemental oxygen |
|
V54.10 |
Aftercare for healing traumatic fracture of arm, unspecified |
|
V54.11 |
Aftercare for healing traumatic fracture of upper arm |
|
V54.12 |
Aftercare for healing traumatic fracture of lower arm |
|
V54.13 |
Aftercare for healing traumatic fracture of hip |
|
V54.14 |
Aftercare for healing traumatic fracture of leg, unspecified |
|
V54.15 |
Aftercare for healing traumatic fracture of upper leg |
|
V54.16 |
Aftercare for healing traumatic fracture of lower leg |
|
V54.17 |
Aftercare for healing traumatic fracture of vertebrae |
|
V54.19 |
Aftercare for healing traumatic fracture of other bone |
|
V54.20 |
Aftercare for healing pathologic fracture of arm, unspecified |
|
V54.21 |
Aftercare for healing pathologic fracture of upper arm |
|
V54.22 |
Aftercare for healing pathologic fracture of lower arm |
|
V54.23 |
Aftercare for healing pathologic fracture of hip |
|
V54.24 |
Aftercare for healing pathologic fracture of leg, unspecified |
|
V54.25 |
Aftercare for healing pathologic fracture of upper leg |
|
V54.26 |
Aftercare for healing pathologic fracture of lower leg |
|
V54.27 |
Aftercare for healing pathologic fracture of vertebrae |
|
V54.29 |
Aftercare for healing pathologic fracture of other bone |
|
V54.81 |
Aftercare following joint replacement |
|
V54.89 |
Other orthopedic aftercare |
|
V58.42 |
Aftercare following surgery for neoplasm |
|
V58.43 |
Aftercare following surgery for injury and trauma |
|
V58.71 |
Aftercare following surgery of the sense organs, NEC |
|
V58.72 |
Aftercare following surgery of the nervous system, NEC |
|
V58.73 |
Aftercare following surgery of the circulatory system, NEC |
|
V58.74 |
Aftercare following surgery of the respiratory system, NEC |
|
V58.75 |
Aftercare following surgery of the teeth, oral cavity, and digestive system, NEC |
|
V58.76 |
Aftercare following surgery of the genitourinary system, NEC |
|
V58.77 |
Aftercare following surgery of the skin and subcutaneous tissue, NEC |
|
V58.78 |
Aftercare following surgery of the musculoskeletal system, NEC |
|
V71.82 |
Observation and evaluation for suspected exposure to anthrax |
|
V71.83 |
Observation and evaluation for suspected exposure to other biological agent |
|
V83.81 |
Cystic fibrosis gene carrier |
|
V83.89 |
Other genetic carrier status |
|
|
|
|
Revised diagnosis code descriptors |
|
|
Code |
Description |
|
402.00 |
Hypertensive heart disease, malignant, without heart failure |
|
402.01 |
Hypertensive heart disease, malignant, with heart failure |
|
402.10 |
Hypertensive heart disease, benign, without heart failure |
|
402.11 |
Hypertensive heart disease, benign, with heart failure |
|
|
|
|
Deleted diagnosis codes |
|
|
Code |
Description |
|
357.8 |
Other inflammatory and toxic neuropathy |
|
359.8 |
Other myopathies |
|
459.1 |
Postphlebetic syndrome |
|
633.0 |
Abdominal pregnancy |
|
633.1 |
Tubal pregnancy |
|
633.2 |
Ovarian pregnancy |
|
633.8 |
Other ectopic pregnancy |
|
633.9 |
Unspecified ectopic pregnancy |
|
770.8 |
Other respiratory problems after birth |
|
771.8 |
Other infections specific to the perinatal period |
|
779.8 |
Other specified conditions originating in the perinatal period |
|
780.9 |
Other general symptoms |
|
795.0 |
Nonspecific abnormal Papanicolaou smear of cervix |
|
795.3 |
Nonspecific positive culture findings |
|
998.3 |
Disruption of operation wound |
|
V01.8 |
Other communicable diseases |
|
V13.2 |
Other genital system and obstetric disorders |
|
V23.4 |
Pregnancy with other poor obstetric history |
|
V54.8 |
Other orthopedic aftercare |
These ICD-9-CM code additions, deletions, and verbiage changes are considered to be effective October 1, 2002 by the American Hospital Association (AHA) and other parties responsible for the maintenance of ICD-9 and the Clinical Modification. However, not all insurance payors will recognize these codes on October 1, 2002 and some may require grace periods until mid-year 2003 before these codes will be recognized. Make certain to check with local insurers to ensure that claim-processing systems have been updated prior to assigning these codes.
By Melody MulaikAuntMinnie.com contributing writer
July 16, 2002
Melody Mulaik is president of Coding Strategies Incorporated.
Related Reading
Do you know who is minding the codes?, March 27, 2002
Necessity criteria compliance critical for PET reimbursement, February 28, 2002
New Year brings new coding and bundling changes, January 18, 2002
New diagnosis guidelines could affect your operations and reimbursement, December 18, 2001
Order compliance equals payment for outpatient radiologists, November 19, 2001
Copyright © 2002 Coding Strategies Incorporated
