CMS Limitations Guide Mammograms and Bone Density Radiology Services

Size: px
Start display at page:

Download "CMS Limitations Guide Mammograms and Bone Density Radiology Services"

Transcription

1 CMS Limitations Guide Mammograms and Bone Density Radiology Services Starting July 1, 2008, CMS has placed numerous medical necessity limits on tests and procedures. This reference guide provides you with all of the latest changes. This guide is not an all-inclusive list of National Coverage Documents (NCD) and Local Coverage Documents (LCD). Please consult the CMS website for additional information at cms.hhs.gov/mcd/search.asp?clickon=search. You can search by LCD or NCD or keyword and region. CMS will deny payment if the correct diagnosis codes are not entered on the order form, and your patient s test or procedure will not be covered. We compiled this information in one location to make it easier for you to find the proper codes for medically necessary diagnoses. It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g. to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination. We will continue to update this list as new CMS limitations are announced. You can always find the most current list on mymunson.org. If you have any questions, please contact Kari Smith, Office Coordinator, at (231) , or Karen Fouch, Manager, Patient Access Services, at (231) Screening Mammograms (L26890)...2 Diagnostic Mammograms (L26890)...3 US Breast & MRI Breast (L26890)...6 Bone Densities (L26385)

2 Screening Mammograms (L26890) V76.11 SCREENING MAMMOGRAM FOR HIGH-RISK PATIENT V76.12 OTHER SCREENING MAMMOGRAM - 2 -

3 Diagnostic Mammograms (L26890) MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST MALIGNANT NEOPLASM OF CENTRAL PORTION OF FEMALE BREAST MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF LOWER-OUTER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF AXILLARY TAIL OF FEMALE BREAST MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE BREAST MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST MALIGNANT NEOPLASM OF OVARY SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF AXILLA AND UPPER LIMB SECONDARY MALIGNANT NEOPLASM OF LUNG SECONDARY MALIGNANT NEOPLASM OF MEDIASTINUM SECONDARY MALIGNANT NEOPLASM OF PLEURA MALIGNANT NEOPLASM OF LIVER SECONDARY SECONDARY MALIGNANT NEOPLASM OF SKIN SECONDARY MALIGNANT NEOPLASM OF BRAIN AND SPINAL CORD SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW SECONDARY MALIGNANT NEOPLASM OF BREAST DISSEMINATED MALIGNANT NEOPLASM OTHER MALIGNANT NEOPLASM OF UNSPECIFIED SITE 217 BENIGN NEOPLASM OF BREAST CARCINOMA IN SITU OF SKIN OF TRUNK EXCEPT SCROTUM CARCINOMA IN SITU OF BREAST NEOPLASM OF UNCERTAIN BEHAVIOR OF SKIN NEOPLASM OF UNCERTAIN BEHAVIOR OF BREAST NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN NEOPLASM OF UNSPECIFIED NATURE OF BREAST PHLEBITIS AND THROMBOPHLEBITIS OF OTHER SITES SOLITARY CYST OF BREAST - 3 -

4 610.1 DIFFUSE CYSTIC MASTOPATHY FIBROADENOSIS OF BREAST FIBROSCLEROSIS OF BREAST MAMMARY DUCT ECTASIA OTHER SPECIFIED BENIGN MAMMARY DYSPLASIAS BENIGN MAMMARY DYSPLASIA UNSPECIFIED INFLAMMATORY DISEASE OF BREAST HYPERTROPHY OF BREAST FISSURE OF NIPPLE FAT NECROSIS OF BREAST ATROPHY OF BREAST GALACTOCELE GALACTORRHEA NOT ASSOCIATED WITH CHILDBIRTH MASTODYNIA LUMP OR MASS IN BREAST OTHER SIGNS AND SYMPTOMS IN BREAST CAPSULAR CONTRACTURE OF BREAST IMPLANT * OTHER SPECIFIED DISORDERS OF BREAST UNSPECIFIED BREAST DISORDER DEFORMITY OF RECONSTRUCTED BREAST DISPROPORTION OF RECONSTRUCTED BREAST ENLARGEMENT OF LYMPH NODES UNSPECIFIED ABNORMAL MAMMOGRAM MAMMOGRAPHIC MICROCALCIFICATION INCONCLUSIVE MAMMOGRAM OTHER (ABNORMAL) FINDINGS ON RADIOLOGICAL EXAMINATION OF BREAST OPEN WOUND OF BREAST WITHOUT COMPLICATION OPEN WOUND OF BREAST COMPLICATED CONTUSION OF BREAST MECHANICAL COMPLICATION OF BREAST PROSTHESIS INFECTION AND INFLAMMATORY REACTION DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST V10.89* PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER SITES V15.89 OTHER SPECIFIED PERSONAL HISTORY PRESENTING HAZARDS TO HEALTH - 4 -

5 V45.83* BREAST IMPLANT REMOVAL STATUS V67.1 FOLLOW-UP EXAMINATION FOLLOWING RADIOTHERAPY V67.2 FOLLOW-UP EXAMINATION FOLLOWING CHEMOTHERAPY V71.1 OBSERVATION FOR SUSPECTED MALIGNANT NEOPLASM *Use ICD-9-CM code for hematoma *ICD-9-CM codes V10.89 and V45.83 may be reported only until clinical stability has been established

6 US Breast & MRI Breast (L26890) MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF FEMALE BREAST MALIGNANT NEOPLASM OF CENTRAL PORTION OF FEMALE BREAST MALIGNANT NEOPLASM OF UPPER-INNER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF LOWER-INNER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF UPPER-OUTER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF LOWER-OUTER QUADRANT OF FEMALE BREAST MALIGNANT NEOPLASM OF AXILLARY TAIL OF FEMALE BREAST MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF FEMALE BREAST MALIGNANT NEOPLASM OF BREAST (FEMALE) UNSPECIFIED SITE MALIGNANT NEOPLASM OF NIPPLE AND AREOLA OF MALE BREAST MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED SITES OF MALE BREAST SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF AXILLA AND UPPER LIMB SECONDARY MALIGNANT NEOPLASM OF SKIN SECONDARY MALIGNANT NEOPLASM OF BREAST OTHER MALIGNANT NEOPLASM OF UNSPECIFIED SITE 217 BENIGN NEOPLASM OF BREAST CARCINOMA IN SITU OF BREAST NEOPLASM OF UNCERTAIN BEHAVIOR OF BREAST NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN NEOPLASM OF UNSPECIFIED NATURE OF BREAST SOLITARY CYST OF BREAST 610.1* DIFFUSE CYSTIC MASTOPATHY 610.2* FIBROADENOSIS OF BREAST 610.3* FIBROSCLEROSIS OF BREAST 610.4* MAMMARY DUCT ECTASIA 610.8* OTHER SPECIFIED BENIGN MAMMARY DYSPLASIAS 610.9* BENIGN MAMMARY DYSPLASIA UNSPECIFIED INFLAMMATORY DISEASE OF BREAST HYPERTROPHY OF BREAST 611.2* FISSURE OF NIPPLE 611.3* FAT NECROSIS OF BREAST 611.4* ATROPHY OF BREAST - 6 -

7 611.5* GALACTOCELE 611.6* GALACTORRHEA NOT ASSOCIATED WITH CHILDBIRTH MASTODYNIA LUMP OR MASS IN BREAST OTHER SIGNS AND SYMPTOMS IN BREAST * OTHER SPECIFIED DISORDERS OF BREAST 611.9* UNSPECIFIED BREAST DISORDER DEFORMITY OF RECONSTRUCTED BREAST DISPROPORTION OF RECONSTRUCTED BREAST UNSPECIFIED ABNORMAL MAMMOGRAM MAMMOGRAPHIC MICROCALCIFICATION INCONCLUSIVE MAMMOGRAM OTHER (ABNORMAL) FINDINGS ON RADIOLOGICAL EXAMINATION OF BREAST MECHANICAL COMPLICATION OF BREAST PROSTHESIS INFECTION AND INFLAMMATORY REACTION DUE TO OTHER INTERNAL PROSTHETIC DEVICE IMPLANT AND GRAFT V10.3 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF BREAST - 7 -

8 Bone Densities (L26385) ICD-9-CM code should be reported for collapse of vertebrae NOS. ICD-9-CM code should be reported as a secondary diagnosis when DXA is performed for subsequent monitoring following a BMM performed by another modality. ICD-9-CM code V45.77 should be reported for women s/p oophorectomy. ICD-9-CM code V58.65 should be reported for an individual on glucocorticoid therapy. ICD-9-CM code V58.69 should be reported for DXA testing while taking medicines for osteoporosis/osteopenia. ICD-9-CM code V67.51 should be reported for an individual who has COMPLETED drug therapy for osteoporosis and is being monitored for response to therapy. ICD-9-CM code should be reported to indicate osteopenia, (only when billing DXA), when used to follow treatment with FDA approved osteoporosis medications. For Bone Density CPT Only: CUSHING'S SYNDROME OSTEOPOROSIS UNSPECIFIED SENILE OSTEOPOROSIS IDIOPATHIC OSTEOPOROSIS DISUSE OSTEOPOROSIS OTHER OSTEOPOROSIS DISORDER OF BONE AND CARTILAGE UNSPECIFIED V58.65 LONG-TERM (CURRENT) USE OF STEROIDS V58.69 LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS V67.51 FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE CLASSIFIED These following diagnoses may support medical necessity for CPT codes 77078, 77079, 77080, 77081, 77083, and G0130, when these tests are performed for bone mass density screening for potential osteopenia/osteoporosis in qualified beneficiaries with estrogen deficiency, vertebral abnormalities/fractures, primary hyperparathyroidism or glucocorticoid administration PRIMARY HYPERPARATHYROIDISM POSTABLATIVE OVARIAN FAILURE PREMATURE MENOPAUSE OTHER OVARIAN FAILURE ECTOPIC HORMONE SECRETION NOT ELSEWHERE CLASSIFIED PREMENOPAUSAL MENORRHAGIA POSTMENOPAUSAL BLEEDING SYMPTOMATIC MENOPAUSAL OR FEMALE CLIMACTERIC STATES POSTMENOPAUSAL ATROPHIC VAGINITIS SYMPTOMATIC STATES ASSOCIATED WITH ARTIFICIAL MENOPAUSE - 8 -

9 627.8 OTHER SPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDERS UNSPECIFIED MENOPAUSAL AND POSTMENOPAUSAL DISORDER PATHOLOGICAL FRACTURE OF VERTEBRAE OSTEOGENESIS IMPERFECTA GONADAL DYSGENESIS NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF MUSCULOSKELETAL SYSTEM CLOSED FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL CLOSED FRACTURE OF FIRST CERVICAL VERTEBRA CLOSED FRACTURE OF SECOND CERVICAL VERTEBRA CLOSED FRACTURE OF THIRD CERVICAL VERTEBRA CLOSED FRACTURE OF FOURTH CERVICAL VERTEBRA CLOSED FRACTURE OF FIFTH CERVICAL VERTEBRA CLOSED FRACTURE OF SIXTH CERVICAL VERTEBRA CLOSED FRACTURE OF SEVENTH CERVICAL VERTEBRA CLOSED FRACTURE OF MULTIPLE CERVICAL VERTEBRAE OPEN FRACTURE OF CERVICAL VERTEBRA UNSPECIFIED LEVEL OPEN FRACTURE OF FIRST CERVICAL VERTEBRA OPEN FRACTURE OF SECOND CERVICAL VERTEBRA OPEN FRACTURE OF THIRD CERVICAL VERTEBRA OPEN FRACTURE OF FOURTH CERVICAL VERTEBRA OPEN FRACTURE OF FIFTH CERVICAL VERTEBRA OPEN FRACTURE OF SIXTH CERVICAL VERTEBRA OPEN FRACTURE OF SEVENTH CERVICAL VERTEBRA OPEN FRACTURE OF MULTIPLE CERVICAL VERTEBRAE CLOSED FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT SPINAL CORD INJURY OPEN FRACTURE OF DORSAL (THORACIC) VERTEBRA WITHOUT SPINAL CORD INJURY CLOSED FRACTURE OF LUMBAR VERTEBRA WITHOUT SPINAL CORD INJURY OPEN FRACTURE OF LUMBAR VERTEBRA WITHOUT SPINAL CORD INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITHOUT SPINAL CORD INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITHOUT SPINAL CORD INJURY CLOSED FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY OPEN FRACTURE OF UNSPECIFIED PART OF VERTEBRAL COLUMN WITHOUT SPINAL CORD INJURY CLOSED FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION OF CORD - 9 -

10 CLOSED FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME CLOSED FRACTURE OF C1-C4 LEVEL WITH CENTRAL CORD SYNDROME CLOSED FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION OF CORD CLOSED FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME CLOSED FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD SYNDROME CLOSED FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF C1-C4 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF C1-C4 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF C1-C4 LEVEL WITH ANTERIOR CORD SYNDROME OPEN FRACTURE OF C1-C4 LEVEL WITH CENTRAL CORD SYNDROME OPEN FRACTURE OF C1-C4 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF C5-C7 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF C5-C7 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF C5-C7 LEVEL WITH ANTERIOR CORD SYNDROME OPEN FRACTURE OF C5-C7 LEVEL WITH CENTRAL CORD SYNDROME OPEN FRACTURE OF C5-C7 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF T1-T6 LEVEL WITH COMPLETE LESION OF CORD CLOSED FRACTURE OF T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME CLOSED FRACTURE OF T1-T6 LEVEL WITH CENTRAL CORD SYNDROME CLOSED FRACTURE OF T1-T6 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF T7-T12 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF T7-T12 LEVEL WITH COMPLETE LESION OF CORD CLOSED FRACTURE OF T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME CLOSED FRACTURE OF T7-T12 LEVEL WITH CENTRAL CORD SYNDROME CLOSED FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF T1-T6 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF T1-T6 LEVEL WITH COMPLETE LESION OF CORD OPEN FRACTURE OF T1-T6 LEVEL WITH ANTERIOR CORD SYNDROME OPEN FRACTURE OF T1-T6 LEVEL WITH CENTRAL CORD SYNDROME OPEN FRACTURE OF T1-T6 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF T7-T12 LEVEL WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF T7-T12 LEVEL WITH COMPLETE LESION OF CORD

11 OPEN FRACTURE OF T7-T12 LEVEL WITH ANTERIOR CORD SYNDROME OPEN FRACTURE OF T7-T12 LEVEL WITH CENTRAL CORD SYNDROME OPEN FRACTURE OF T7-T12 LEVEL WITH OTHER SPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY OPEN FRACTURE OF LUMBAR SPINE WITH SPINAL CORD INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITH COMPLETE CAUDA EQUINA LESION CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY CLOSED FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITH UNSPECIFIED SPINAL CORD INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITH COMPLETE CAUDA EQUINA LESION OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER CAUDA EQUINA INJURY OPEN FRACTURE OF SACRUM AND COCCYX WITH OTHER SPINAL CORD INJURY CLOSED FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY OPEN FRACTURE OF UNSPECIFIED VERTEBRA WITH SPINAL CORD INJURY E932.0 ADRENAL CORTICAL STEROIDS CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE V45.77 ACQUIRED ABSENCE OF ORGAN GENITAL ORGANS V49.81 ASYMPTOMATIC POSTMENOPAUSAL STATUS (AGE-RELATED) (NATURAL) V58.65 LONG-TERM (CURRENT) USE OF STEROIDS

CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130:

CPT 76977, 77078, 77079, 77080, 77081, 77083, or HCPCS G0130: Bone Mass Measurements Coverage Information Noridian Administrative Services (NAS), LLC, is providing coverage information regarding Bone Mass Measurements (BMM) in response to multiple provider inquiries.

More information

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328)

Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Local Coverage Determination (LCD): Screening and Diagnostic Mammography (L29328) Contractor Information Contractor Name First Coast Service Options, Inc. LCD Information Document Information LCD ID L29328

More information

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests

Medicare Part B. Mammograms - Updated Billing Guide for Screening and Diagnostic Tests Mammograms - Updated Billing Guide for Screening and Diagnostic Tests This article from Medicare B News Issue 223 dated October 21, 2005 is being updated and reprinted to ensure that the Noridian Administrative

More information

Jurisdiction Ohio. Retirement Date N/A

Jurisdiction Ohio. Retirement Date N/A If you wish to save the PDF, please ensure that you change the file extension to.pdf (from.ashx). Local Coverage Determination (LCD): BONE Mass Measurement (L31854) Contractor Information Contractor Name

More information

Medical Policy Original Effective Date: Revised Date: Page 1 of 8

Medical Policy Original Effective Date: Revised Date: Page 1 of 8 Page 1 of 8 Breast Implant Removal and/or Replacement and Capsulectomy Disclaimer Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on

More information

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8

Medical Policy Original Effective Date: 11-19-08 Revised Date: 1-27-16 Page 1 of 8 Page 1 of 8 Disclaimer Description Coverage Determination Refer to the member s specific benefit plan and Schedule of Benefits to determine coverage. This may not be a benefit on all plans, or the plan

More information

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE:

SUBJECT: MANAGEMENT OF BREAST EFFECTIVE DATE: 12/16/99 IMPLANTS REVISED DATE: MEDICAL POLICY SUBJECT: MANAGEMENT OF BREAST PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical policy

More information

Breast Implants and Reconstruction

Breast Implants and Reconstruction Last Review Date: October 9, 2015 Number: MG.MM.SU.fv2 Medical Guideline Disclaimer Property of EmblemHealth. All rights reserved. The treating physician or primary care provider must submit to EmblemHealth

More information

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc.

CHAPTER 2. Neoplasms (C00-D49) March 2014. 2014 MVP Health Care, Inc. Neoplasms (C00-D49) March 2014 2014 MVP Health Care, Inc. CHAPTER SPECIFIC CATEGORY CODE BLOCKS C00-C14 Malignant neoplasms of lip, oral cavity and pharynx C15-C26 Malignant neoplasms of digestive organs

More information

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes

Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes Crosswalk of Common Spine ICD-9-CM Codes to ICD-10 Codes As of October 1, 2015, all health care entities covered by the Health Insurance Portability and Accountability Act (HIPAA) will be required to use

More information

CMS Limitations Guide Mammography & Bone Mass Measurement

CMS Limitations Guide Mammography & Bone Mass Measurement Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations guide provides you with the latest changes.

More information

LCD for Prostate Specific Antigen (PSA)

LCD for Prostate Specific Antigen (PSA) LCD for Prostate Specific Antigen (PSA) Applicable CPT Code(s): 84152 Prostate Specific Antigen (PSA); Complexed (Direct Measurement) 84153 Prostate Specific Antigen (PSA); Total 84154 Prostate Specific

More information

Breast Reconstruction Following Mastectomy or Lumpectomy

Breast Reconstruction Following Mastectomy or Lumpectomy Breast Reconstruction Following Mastectomy or Lumpectomy [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click Cartas

More information

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014

Spinal Surgery Functional Status and Quality of Life Outcome Specifications 2015 (01/01/2013 to 12/31/2013 Dates of Procedure) September 2014 Description Methodology For patients ages 18 years and older who undergo a lumbar discectomy/laminotomy or lumbar spinal fusion procedure during the measurement year, the following measures will be calculated:

More information

ICD-10 Diagnostic Coding for. Breast Reconstruction

ICD-10 Diagnostic Coding for. Breast Reconstruction ICD-10 Diagnostic Coding for Webinar Hosted by: Breast Reconstruction December 5, 2013 Presented by: Kim Pollock, RN, MBA, CPC Meet Kim Pollock RN, MBA, CPC Kim Pollock, RN, MBA, CPCspecializes in streamlining

More information

ICD-9-CM coding for patients with Spinal Cord Injury*

ICD-9-CM coding for patients with Spinal Cord Injury* ICD-9-CM coding for patients with Spinal Cord Injury* indicates intervening codes have been left out of this list. OTHER DISORDERS OF THE CENTRAL NERVOUS SYSTEM (340-349) 344 Other paralytic syndromes

More information

CERVICAL PROCEDURES PHYSICIAN CODING

CERVICAL PROCEDURES PHYSICIAN CODING CERVICAL PROCEDURES PHYSICIAN CODING Anterior Cervical Discectomy with Interbody Fusion (ACDF) Anterior interbody fusion, with discectomy and decompression; cervical below C2 22551 first interspace 22552

More information

190.25 - Alpha-fetoprotein

190.25 - Alpha-fetoprotein Other Names/Abbreviations AFP 190.25 - Alpha-fetoprotein Alpha-fetoprotein (AFP) is a polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring the response of certain

More information

RHEUMATOLOGY ICD-10 CROSSWALK

RHEUMATOLOGY ICD-10 CROSSWALK RHEUMATOLOGY ICD-10 CROSSWALK ICD is revised periodically and is currently in its tenth edition and will be implemented in the United States on October 1, 2015. There is an annual minor update and three-yearly

More information

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too.

Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Male Breast Cancer Introduction Breast cancer is cancer that starts in the cells of the breast. Breast cancer happens mainly in women. But men can get it too. Many people do not know that men can get breast

More information

2011 Radiology Diagnosis Coding Update Questions and Answers

2011 Radiology Diagnosis Coding Update Questions and Answers 2011 Radiology Diagnosis Coding Update Questions and Answers How can we subscribe to the Coding Clinic for ICD-9 guidelines and updates? The American Hospital Association publishes this quarterly newsletter.

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY BREAST RECONSTRUCTION POST MASTECTOMY CLINICAL POLICY Policy Number: SURGERY 095.11 T2 Effective Date: January 1, 2016 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS... COVERAGE RATIONALE...

More information

CMS Limitations Guide - Laboratory Services

CMS Limitations Guide - Laboratory Services CMS Limitations Guide - Laboratory Services Starting October 1, 2015, CMS will update their exisiting medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitattions

More information

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes

Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Anesthesia ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Anesthesia and Top 25 Codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or

More information

ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015

ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015 Presented by: Teri Romano, RN, MBA, CPC, CMDP ICD 10 CM IMPLEMENTATION DATE OCT 1, 2015 Source: http://journal.ahima.org/2015/02/04/us house committee to hold hearing on icd 10 implementation/ 2 2015 Web_Non

More information

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN MEDICAL POLICY EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN Policy Number: 2015T0004W Effective Date: December 1, 2015 Table of Contents BENEFIT CONSIDERATIONS COVERAGE RATIONALE APPLICABLE CODES..

More information

Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)

Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Contractor Information Contractor Name Novitas Solutions, Inc. LCD Information Document Information LCD

More information

Anesthesia Cross Coder. Essential links from CPT codes to ICD-9-CM and HCPCS codes

Anesthesia Cross Coder. Essential links from CPT codes to ICD-9-CM and HCPCS codes Anesthesia Cross Coder Essential links from CPT codes to ICD-9-CM and HCPCS codes Contents Introduction... i CPT Anesthesia to Procedure Crosswalk...i Format...i Icon Key...ii CPT Codes...ii Code Links...iii

More information

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer

Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Guideline for the Imaging of Patients Presenting with Breast Symptoms incorporating the guideline for the use of MRI in breast cancer Version History Version Date Summary of Change/Process 0.1 09.01.11

More information

BREAST RECONSTRUCTION POST MASTECTOMY

BREAST RECONSTRUCTION POST MASTECTOMY COVERAGE DETERMINATION GUIDELINE BREAST RECONSTRUCTION POST MASTECTOMY Guideline Number: CDG.003.05 Effective Date: January 1, 2016 Table of Contents COVERAGE RATIONALE... DEFINITIONS... APPLICABLE CODES...

More information

NEOPLASMS C00 D49. Presented by Jan Halloran CCS

NEOPLASMS C00 D49. Presented by Jan Halloran CCS NEOPLASMS C00 D49 Presented by Jan Halloran CCS 1 INTRODUCTION A neoplasm is a new or abnormal growth. In the ICD-10-CM classification system, neoplastic disease is classified in categories C00 through

More information

HealthyWoman Program (HWP) Enrollment Information

HealthyWoman Program (HWP) Enrollment Information HealthyWoman Program (HWP) Enrollment Information HWP Intake Site N O : The following information will help determine if you are eligible for the Department of Health, HealthyWoman Program. It will also

More information

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA

Breast Imaging Made Brief and Simple. Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA Breast Imaging Made Brief and Simple Jane Clayton MD Associate Professor Department of Radiology LSUHSC New Orleans, LA What women are referred for breast imaging? Two groups of women are referred for

More information

Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes

Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes Certified Registered Nurse Anesthetist ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for CRNA s and Top 25 Codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant

More information

The Lewin Group undertook the following steps to identify the guidelines relevant to the 11 targeted procedures:

The Lewin Group undertook the following steps to identify the guidelines relevant to the 11 targeted procedures: Guidelines The following is a list of proposed medical specialty guidelines that have been found for the 11 targeted procedures to be included in the Medicare Imaging Demonstration. The list includes only

More information

ICD-10 and General Surgery

ICD-10 and General Surgery ICD-10 and General Surgery Steven M. Verno CMBS, CEMCS, CMSCS, CPM-MCS Page 1 of 25 ICD-10 and General Surgery Steven M. Verno Revised January 13, 2014 Note: ICD-9-CM and ICD-10 are owned and copyrighted

More information

Benign Breast Disorders

Benign Breast Disorders Benign Breast Disorders Valerie Swiatkowski, MD Medical Student Lecture Introduction 16% of women ages 40-69 will seek advice from their physician regarding breast complaints over 10 years. Failure to

More information

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN

EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN CLINICAL POLICY EPIDURAL STEROID AND FACET INJECTIONS FOR SPINAL PAIN Policy Number: PAIN 019.16 T2 Effective Date: December 1, 2015 Table of Contents CONDITIONS OF COVERAGE... BENEFIT CONSIDERATIONS..

More information

Medicare Diagnosis By Dr. Ron Short, DC, MCS-P

Medicare Diagnosis By Dr. Ron Short, DC, MCS-P Medicare Diagnosis By Dr. Ron Short, DC, MCS-P Diagnosis o The diagnosis is one of two codes that you place on the CMS 1500 form when you submit a claim. o The diagnosis communicates the patient s condition

More information

Physician Coding and Payment Guide 2015

Physician Coding and Payment Guide 2015 Targeted Drug Delivery Physician Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party sources and is subject

More information

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment

KYPHON. Reimbursement Guide. Physician Reimbursement. Balloon Kyphoplasty Procedure. ICD-9-CM Diagnosis Codes. CPT Codes and Payment KYPHON Balloon Kyphoplasty Procedure Reimbursement Guide ICD-9-CM Diagnosis Codes Providers should report the ICD-9-CM diagnosis code that most accurately describes the patient s condition. Please refer

More information

Breast Cancer. Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine

Breast Cancer. Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine Breast Cancer Mary Yamashita, M.D. Assistant Professor of Radiology Breast Imaging University of Southern California Keck School of Medicine DISCLOSURE Neither I nor my spouse has any relevant financial

More information

Breast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor.

Breast Cancer. Sometimes cells keep dividing and growing without normal controls, causing an abnormal growth called a tumor. Breast Cancer Introduction Cancer of the breast is the most common form of cancer that affects women but is no longer the leading cause of cancer deaths. About 1 out of 8 women are diagnosed with breast

More information

DISEASES OF THE GENITOURINARY SYSTEM

DISEASES OF THE GENITOURINARY SYSTEM DISEASES OF THE GENITOURINARY SYSTEM NEPHRITIS, NEPHROTIC SYNDROME ANS NEPHROSIS (580 589.9) 580 ACUTE GLOMERULONEPHRITIS 580.0 WITH LESION OF PROLIFERATIVE GLOMERULONEPHRITIS 580.4 WITH LESION OF RAPIDLY

More information

Diagnostic Imaging Exams

Diagnostic Imaging Exams Guide for Chiropractors Diagnostic Imaging Exams CREATED FOR OUR CHIROPRACTIC PARTNERS This document has been prepared by the specialized, board-certified radiologists who interpret patient exams for Center

More information

X-Plain Breast Cancer Reference Summary

X-Plain Breast Cancer Reference Summary X-Plain Breast Cancer Reference Summary The risk of breast cancer among Asian Americans living in the U.S. is relatively low compared to caucasian women. However, there is concern that the risk of breast

More information

ICD-10-CM Official Guidelines for Coding and Reporting

ICD-10-CM Official Guidelines for Coding and Reporting 2013 Narrative changes appear in bold text Items underlined have been moved within the guidelines since the 2012 version Italics are used to indicate revisions to heading changes The Centers for Medicare

More information

Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy

Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy Metastatic Cervical Cancer s/p Radiation Therapy, Radical Hysterectomy and Attempted Modified Internal Hemipelvectomy Sarah Hutto,, MSIV Marc Underhill, M.D. January 27, 2009 Past History 45 yo female

More information

Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125)

Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125) Local Coverage Determination (LCD): MolDX: Breast Cancer Assay: Prosigna (L36125) Contractor Information Contractor Name Palmetto GBA LCD Information Document Information LCD ID L36125 Original ICD-9 LCD

More information

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services Coding and Payment Guide for Dental Services A comprehensive coding, billing, and reimbursement resource for dental services 2011 Contents Introduction...1 Coding Systems... 1 Claim Forms... 2 Contents

More information

Hospital-based SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview

Hospital-based SNF Coding Tip Sheet: Top 25 codes and ICD-10 Chapter Overview Hospital-based SNF Coding Tip Sheet: Top 25 codes and Chapter Overview Chapter 5 - Mental, Behavioral and Neurodevelopmental Disorders (F00-F99) Classification improvements (different categories) expansions:

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [For the list of services and procedures that need preauthorization, please refer to www.mcs.pr Go to Comunicados a Proveedores, and click

More information

Consolidated Laboratory Services ICD9 ICD10 Crosswalk OB/GYN ICD9 Description ICD10 Menstral Abnormalities 625.3 Dysmenorrhea N94.6 625.

Consolidated Laboratory Services ICD9 ICD10 Crosswalk OB/GYN ICD9 Description ICD10 Menstral Abnormalities 625.3 Dysmenorrhea N94.6 625. Consolidated Laboratory Services ICD9 ICD10 Crosswalk OB/GYN ICD9 Description ICD10 Menstral Abnormalities 625.3 Dysmenorrhea N94.6 625.4 Premenstrual Syndrome N94.3 626 Amenorrhea N91.2 626.1 Oligomenorrhea

More information

Patient Information. Anterior Lumbar Interbody Fusion

Patient Information. Anterior Lumbar Interbody Fusion Patient Information Anterior Lumbar Interbody Fusion Table of Contents Anatomy of the Spine 2 The Healthy Spine 3 General Treatment Options 4 General Conditions of the Lumbar Spine 5 What is Spondylolisthesis?

More information

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D.

Breast Cancer: from bedside and grossing room to diagnoses and beyond. Adriana Corben, M.D. Breast Cancer: from bedside and grossing room to diagnoses and beyond Adriana Corben, M.D. About breast anatomy Breasts are special organs that develop in women during puberty when female hormones are

More information

Breast Reconstruction Surgery

Breast Reconstruction Surgery Breast Reconstruction Surgery I. Policy University Health Alliance (UHA) will reimburse for Breast Reconstruction Surgery when it is determined to be medically necessary and when it meets the medical criteria

More information

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes

Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Pathology ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Pathology and Top 25 codes Chapter 2 Neoplasms (C00-D49) Classification improvements Code expansions Significant expansions or revisions

More information

Early-stage Breast Cancer Treatment: A Patient and Doctor Dialogue

Early-stage Breast Cancer Treatment: A Patient and Doctor Dialogue page 1 Early-stage Breast Cancer Treatment: A Patient and Doctor Dialogue Q: What is breast cancer, and what type do I have? A: Cancer is a disease in which cells become abnormal and form more cells in

More information

Contents. Introduction 1. Anatomy of the Spine 1. 2. Spinal Imaging 7. 3. Spinal Biomechanics 23. 4. History and Physical Examination of the Spine 33

Contents. Introduction 1. Anatomy of the Spine 1. 2. Spinal Imaging 7. 3. Spinal Biomechanics 23. 4. History and Physical Examination of the Spine 33 Contents Introduction 1. Anatomy of the Spine 1 Vertebrae 1 Ligaments 3 Intervertebral Disk 4 Intervertebral Foramen 5 2. Spinal Imaging 7 Imaging Modalities 7 Conventional Radiographs 7 Myelography 9

More information

CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009

CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009 CMS Imaging Efficiency Measures Included in Hospital Outpatient Quality Data Reporting Program (HOP QDRP) 2009 OP 8: MRI LUMBAR SPINE FOR LOW BACK PAIN Measure Description: This measure estimates the percentage

More information

Medical Review Criteria Breast Surgeries

Medical Review Criteria Breast Surgeries Medical Review Criteria Breast Surgeries Effective Date: May 25, 2016 Subject: Breast Surgeries Policy: HPHC covers medically necessary breast surgeries including mastectomy, breast reconstruction, reduction

More information

ENTERAL NUTRITION Policy/CPT ICD-10 ICD-10 Description ICD-9 ICD-9 Description EPA 870001100 N18.6 End stage renal disease 585.

ENTERAL NUTRITION Policy/CPT ICD-10 ICD-10 Description ICD-9 ICD-9 Description EPA 870001100 N18.6 End stage renal disease 585. ENTERAL NUTRITION Policy/CPT ICD-10 ICD-10 Description ICD-9 ICD-9 Description EPA 870001100 N18.6 End stage renal disease 585.6 End stage renal disease EPA 870001101 C00.0 Malignant neoplasm of external

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Preauthorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: Revised: This policy applies

More information

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma

Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Rotation Specific Goals & Objectives: University Health Network-Princess Margaret Hospital/ Sunnybrook Breast/Melanoma Medical Expert: Breast Rotation Specific Competencies/Objectives 1.0 Medical History

More information

Ambulatory Surgery Center Coding and Payment Guide 2015

Ambulatory Surgery Center Coding and Payment Guide 2015 Targeted Drug Delivery Ambulatory Surgery Center Coding and Payment Guide 2015 Flowonix Medical has compiled this coding information for your convenience. This information is gathered from third party

More information

Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7

Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7 Therapist Name: Phone: Referral Form & Instructions Questions? Call 1 888 284 5433 and press 7 1 2 Indicate all products that might be appropriate for your patient. Please check all products that might

More information

Mammograms & Breast Health. An Information Guide for Women U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Centers for Disease Control and Prevention

Mammograms & Breast Health. An Information Guide for Women U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. Centers for Disease Control and Prevention U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Mammograms & Breast Health An Information Guide for Women This booklet was developed by the Centers for Disease Control

More information

General Thoracic Surgery ICD9 to ICD10 Crosswalks. C34.11 Malignant neoplasm of upper lobe, right bronchus or lung

General Thoracic Surgery ICD9 to ICD10 Crosswalks. C34.11 Malignant neoplasm of upper lobe, right bronchus or lung ICD-9 Code ICD-9 Description ICD-10 Code ICD-10 Description 150.3 Malignant neoplasm of upper third of esophagus C15.3 Malignant neoplasm of upper third of esophagus 150.4 Malignant neoplasm of middle

More information

Adult Spine Rotation Specific Evaluation Orthopaedic Surgery Training Program School of Medicine, Queen s University

Adult Spine Rotation Specific Evaluation Orthopaedic Surgery Training Program School of Medicine, Queen s University Adult Spine Rotation Specific Evaluation Orthopaedic Surgery Training Program School of Medicine, Queen s University CanMEDS Roles / Competencies Name: PGY Rotation Dates: s s Exceeds N/A Attending Staff:

More information

Breast Implants: Local Complications and Adverse Outcomes

Breast Implants: Local Complications and Adverse Outcomes Breast Implants: Local Complications and Adverse Outcomes This booklet highlights the most common problems associated with silicone gel-filled and saline-filled breast implants: those that occur in the

More information

Management of spinal cord compression

Management of spinal cord compression Management of spinal cord compression (SUMMARY) Main points a) On diagnosis, all patients should receive dexamethasone 10mg IV one dose, then 4mg every 6h. then switched to oral dose and tapered as tolerated

More information

Common Breast Complaints:

Common Breast Complaints: : Palpable mass Abnormal mammogram with normal physical exam Vague thickening or nodularity Nipple Discharge Breast pain Breast infection or inflammation The physician s goal is to determine whether the

More information

Clinical Policy Guideline

Clinical Policy Guideline Clinical Policy Guideline Policy Title: Bone Density Testing Policy No: B0215A.00 Effective Date: 01/01/15 Date Reviewed: 03/25/15 I. DEFINITION/BACKGROUND Bone density testing is used to estimate the

More information

Phone: 1-877-336-3736 Fax: 1-877-556-3737 M F 8:00 am 9:00 pm ET

Phone: 1-877-336-3736 Fax: 1-877-556-3737 M F 8:00 am 9:00 pm ET QUICK REFERENCE CODING & BILLING GUIDE PHYSICIAN OFFICE CMS National Coverage Determination and Q-Code for PROVENGE Simplifies patient coverage criteria Clarifies coding requirements Expedites electronic

More information

ICD-10 Coding for Audiology

ICD-10 Coding for Audiology ICD-10 Coding for Audiology Mary Sue Fino-Szumski, Ph.D., M.B.A. Vanderbilt University School of Medicine Vanderbilt Bill Wilkerson Center Department of Hearing and Speech Sciences Disclosure Financial

More information

Highlights of the Revised Official ICD-9-CM Guidelines for Coding and Reporting Effective October 1, 2008

Highlights of the Revised Official ICD-9-CM Guidelines for Coding and Reporting Effective October 1, 2008 Highlights of the Revised Official ICD-9-CM Guidelines for Coding and Reporting Effective October 1, 2008 Please refer to the complete ICD-9-CM Official Guidelines for Coding and Reporting posted on this

More information

Information for the Patient About Surgical

Information for the Patient About Surgical Information for the Patient About Surgical Decompression and Stabilization of the Spine Aging and the Spine Daily wear and tear, along with disc degeneration due to aging and injury, are common causes

More information

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required]

Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Accelerated Partial Breast Irradiation (APBI) for Breast Cancer [Pre-authorization Required] Medical Policy: MP-SU-01-11 Original Effective Date: February 24, 2011 Reviewed: February 24, 2012 Revised:

More information

Continuing Medical Education Article Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias JNM, July 2012, Volume 53, Number 7

Continuing Medical Education Article Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias JNM, July 2012, Volume 53, Number 7 Continuing Medical Education Article Imaging of Multiple Myeloma and Related Plasma Cell Dyscrasias JNM, July 2012, Volume 53, Number 7 Authors Ronald C. Walker 1,2, Tracy L. Brown 3, Laurie B. Jones-Jackson

More information

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services

Coding and Payment Guide for Dental Services. A comprehensive coding, billing, and reimbursement resource for dental services Coding and Payment Guide for Dental Services A comprehensive coding, billing, and reimbursement resource for dental services 2014 Contents Introduction...1 Coding Systems... 1 Claim Forms... 2 Contents

More information

Breast Cancer Understanding your diagnosis

Breast Cancer Understanding your diagnosis Breast Cancer Understanding your diagnosis Let s Make Cancer History 1 888 939-3333 cancer.ca Breast Cancer Understanding your diagnosis When you first hear that you have cancer, you may feel alone and

More information

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28)

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) Tracking Information Publication Number Manual Section Number 100-3 190.28 Manual Section Title Tumor Antigen by

More information

CMS Limitations Guide - Radiology Services

CMS Limitations Guide - Radiology Services CMS Limitations Guide - Radiology Services Starting October 1, 2015, CMS will update their existing medical necessity limitations on tests and procedures to correspond to ICD-10 codes. This limitations

More information

OVARIAN CANCER IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY IN WOMEN. Name of Student HTHSCI 1110 WEBER STATE UNIVERSITY.

OVARIAN CANCER IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY IN WOMEN. Name of Student HTHSCI 1110 WEBER STATE UNIVERSITY. Ovarian Cancer 2 OVARIAN CANCER IS A MAJOR CAUSE OF MORBIDITY AND MORTALITY IN WOMEN by Name of Student HTHSCI 1110 WEBER STATE UNIVERSITY Ogden, Utah Instructor s Name Date Ovarian Cancer 2 Background

More information

Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease)

Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease) Spine University s Guide to Vertebral Osteonecrosis (Kummel's Disease) 2 Introduction Kummel's disease is a collapse of the vertebrae (the bones that make up the spine). It is also called vertebral osteonecrosis.

More information

LOW BACK PAIN; MECHANICAL

LOW BACK PAIN; MECHANICAL 1 ORTHO 16 LOW BACK PAIN; MECHANICAL Background This case definition was developed by the Armed Forces Health Surveillance Center (AFHSC) for the purpose of epidemiological surveillance of a condition

More information

Fast Forward. ICD-9-CM Code ICD-10-CM Code(s) ICD-9-CM Code ICD-10-CM Code(s) ICD-10-CM Codes. (cont.)

Fast Forward. ICD-9-CM Code ICD-10-CM Code(s) ICD-9-CM Code ICD-10-CM Code(s) ICD-10-CM Codes. (cont.) Top 50 2014 ICD-9-CM Code Code(s) ICD-9-CM Code Code(s) V72.31 Routine gynecological exam Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings * Use additional code

More information

Using the ICD-10-CM. The Alphabetic Index helps you determine which section to refer to in the Tabular List. It does not always provide the full code.

Using the ICD-10-CM. The Alphabetic Index helps you determine which section to refer to in the Tabular List. It does not always provide the full code. Using the ICD-10-CM Selecting the Correct Code To determine the correct International Classification of Diseases, 10 Edition, Clinical Modification (ICD-10-CM) code, follow these two steps: Step 1: Look

More information

Frequently Asked Questions About Ovarian Cancer

Frequently Asked Questions About Ovarian Cancer Media Contact: Gerri Gomez Howard Cell: 303-748-3933 gerri@gomezhowardgroup.com Frequently Asked Questions About Ovarian Cancer What is ovarian cancer? Ovarian cancer is a cancer that forms in tissues

More information

Current Status and Perspectives of Radiation Therapy for Breast Cancer

Current Status and Perspectives of Radiation Therapy for Breast Cancer Breast Cancer Current Status and Perspectives of Radiation Therapy for Breast Cancer JMAJ 45(10): 434 439, 2002 Masahiro HIRAOKA, Masaki KOKUBO, Chikako YAMAMOTO and Michihide MITSUMORI Department of Therapeutic

More information

ASPIRATION OF PALPABLE CYST

ASPIRATION OF PALPABLE CYST CYSTS ASPIRATION OF PALPABLE CYST GALACTOCELE New lump in nursing mother-soft to firm non-tender Treatment Aspiration FAT NECROSIS Usually there is a history of trauma - MVA, surgery. The fat dies and

More information

Understanding the ICD-10-CM Neoplasm Coding Guidelines

Understanding the ICD-10-CM Neoplasm Coding Guidelines Understanding the ICD-10-CM Neoplasm Coding Guidelines Sarah A. Serling, CCS, CPC, CCS-P, CPC-H, CEMC, CPC-I, Approved ICD-10-CM/PCS Trainer October 14, 2015 Objectives In this session we will: Examine

More information

Recommendations for cross-sectional imaging in cancer management, Second edition

Recommendations for cross-sectional imaging in cancer management, Second edition www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Breast cancer Faculty of Clinical Radiology www.rcr.ac.uk Contents Breast cancer 2 Clinical background 2 Who

More information

Spinal Cord Injury Education. An Overview for Patients, Families, and Caregivers

Spinal Cord Injury Education. An Overview for Patients, Families, and Caregivers Spinal Cord Injury Education An Overview for Patients, Families, and Caregivers Spinal Cord Anatomy A major component of the Central Nervous System (CNS) It is 15 to 16 inches long, and weighs 1 to 2 ounces

More information

MEDICAL POLICY Chiropractic Services & Spinal Manipulation

MEDICAL POLICY Chiropractic Services & Spinal Manipulation POLICY........ PG-0150 EFFECTIVE......01/13/15 LAST REVIEW... 06/14/16 MEDICAL POLICY Chiropractic Services & Spinal Manipulation GUIDELINES This policy does not certify benefits or authorization of benefits,

More information

Breast Cancer. Presentation by Dr Mafunga

Breast Cancer. Presentation by Dr Mafunga Breast Cancer Presentation by Dr Mafunga Breast cancer in the UK Breast cancer is the second most common cancer in women. Around 1 in 9 women will develop breast cancer It most commonly affects women over

More information

Ductal carcinoma in situ (DCIS)

Ductal carcinoma in situ (DCIS) DIAGNOSIS: DCIS Ductal carcinoma in situ (DCIS) This factsheet gives information on an early form of breast cancer called ductal carcinoma in situ (DCIS). It explains what it is, how your breast is made

More information

D. FREQUENTLY ASKED QUESTIONS

D. FREQUENTLY ASKED QUESTIONS ACR BI-RADS ATLAS D. FREQUENTLY ASKED QUESTIONS 1. Under MQSA, is it necessary to include a numeric assessment code (i.e., 0, 1, 2, 3, 4, 5, or 6) in addition to the assessment category in all mammography

More information

If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time.

If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. If you or a loved one have suffered because of a negligent error during spinal surgery, you will be going through a difficult time. You may be worried about your future, both in respect of finances and

More information

Breast cancer. A guide for journalists on breast cancer and its treatment

Breast cancer. A guide for journalists on breast cancer and its treatment Breast cancer A guide for journalists on breast cancer and its treatment Contents Contents 2 3 Section 1: Breast Cancer 4 i. What is breast cancer? 4 ii. Types of breast cancer 4 iii. Causes and risk factors

More information