L28905-LCD

LCD/NCD Portal

Automated World Health

Local Coverage Determination (LCD) for Magnetic Resonance Imaging of the

Orbit, Face, and/or Neck (L28905)

Contractor Information

Contractor Name First Coast Service Options, Inc.

Contractor Number 09101

Contractor Type MAC - Part A

LCD Information

Document Information

LCD ID Number L28905

LCD Title Magnetic Resonance Imaging of the Orbit, Face, and/or Neck

Contractor's Determination Number A70540

Primary Geographic Jurisdiction Florida

Oversight Region Region IV

AMA CPT/ADA CDT Copyright Statement

CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.

Original Determination Effective Date

For services performed on or after 02/16/2009

Original Determination Ending Date

Revision Effective Date

For services performed on or after 07/07/2011

Revision Ending Date

CMS National Coverage Policy

Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See § 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: Change Request 7296, Transmittals 132 and 2171, dated March 4, 2011

Change Request 7441, Transmittals 134 and 2293, dated August 26,2011

CMS Manual System, Pub. 100- , Medicare National Coverage Determinations, Chapter 1, Part 4, Section 220.2 CMS Manual System, Pub. 100- , Medicare Claims Processing Manual, Chapter 13, Section 40

Indications and Limitations of Coverage and/or Medical Necessity

Magnetic Resonance Imaging (MRI) is a noninvasive diagnostic imaging modality used to diagnose a variety of central nervous system disorders. MRI provides superior tissue contrast when compared to CT, is able to image in multiple planes, is not affected by bone artifact, provides vascular imaging capability, and makes use of safer contrast media (gadolinium chelate agents). Its major disadvantage over CT is the longer scanning time required for study, making it less useful for emergency evaluations. Contraindications include patients with cardiac pacemakers, implanted neurostimulators, cochlear implants, metal in the eye and older ferromagnetic intracranial aneurysm clips. All of these may be potentially displaced when exposed to the powerful magnetic fields used in MRI.

Medicare will consider MRI of the Orbit, Face, and/or Neck medically reasonable and necessary when used to diagnose and characterize pathology of the nasopharynx, oropharynx, and neck including tumors, infection, soft tissue pathologies, and congenital abnormalities.

The MRI is not covered when the following patient-specific contraindications are present:

• MRI is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms unless the Medicare beneficiary meets the provisions of the following exceptions:

Effective for claims with dates of service on or after July 7, 2011, the contraindications will not apply to pacemakers when used according to the FDA-approved labeling in an MRI environment, or effective for claims with dates of service on or after February 24, 2011, CMS believes that the evidence is promising although not yet convincing that MRI will improve patient health outcomes if certain safeguards are in place to ensure that the exposure of the device to an MRI environment adversely affects neither the interpretation of the MRI result nor the proper functioning of the implanted device itself. We believe that specific precautions (as listed below) could maximize benefits of MRI exposure for beneficiaries enrolled in clinical trials designed to assess the utility and safety of MRI exposure. Therefore, CMS determines that MRI will be covered by Medicare when provided in a clinical study under section 1862(a)(1)(E) (consistent with section 1142 of the Act) through the Coverage with Study Participation (CSP) form of Coverage with Evidence Development (CED) if the study meets the criteria in each of the three paragraphs in CMS Pub 100-03, CMS National Coverage Determination Manual, Chapter 1, Section 220.2.C.1

• MRI during a viable pregnancy is also contraindicated at this time.

• The danger inherent in bringing ferromagnetic materials within range of MRI units generally constrains the use of MRI on acutely ill patients requiring life support systems and monitoring devices that employ ferromagnetic materials.

• In addition, the long imaging time and the enclosed position of the patient may result in claustrophobia, making patients who have a history of claustrophobia unsuitable candidates for MRI procedures.

Nationally Non-Covered Indications:

CMS has determined that MRI of cortical bone and calcifications, and procedures involving spatial resolution of bone and calcifications, are not considered reasonable and necessary indications within the meaning of section 1862(a)(1)(A) of the Act, and are therefore non-covered.

When Magnetic Resonance Imaging is used for an investigational purpose, an acceptable advance notice of Medicare’s denial of payment must be given to the patient when the provider does not want to accept financial responsibility for the service.

In some instances, MRI of the brain, as well as MRI of the orbit, face, and/or neck may be medically necessary on the same day. The medical record should document the medical necessity for these two procedures being performed on the same day.

Initial imaging of the thyroid should be done with ultrasound or nuclear medicine, unless there is a known carcinoma present.

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

012x Hospital Inpatient (Medicare Part B only)

013x Hospital Outpatient

014x Hospital - Laboratory Services Provided to Non-patients

021x Skilled Nursing - Inpatient (Including Medicare Part A)

022x Skilled Nursing - Inpatient (Medicare Part B only)

023x Skilled Nursing - Outpatient

075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)

085x Critical Access Hospital

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

032X Radiology - Diagnostic - General Classification

061X Magnetic Resonance Technology (MRT) - General Classification

CPT/HCPCS Codes

70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTRAST MATERIAL(S)

70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITH CONTRAST MATERIAL(S)

70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND/OR NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES

ICD-9 Codes that Support Medical Necessity

017.30 - 017.36 TUBERCULOSIS OF EYE UNSPECIFIED EXAMINATION - TUBERCULOSIS OF EYE TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)

017.40 - 017.46 TUBERCULOSIS OF EAR UNSPECIFIED EXAMINATION - TUBERCULOSIS OF EAR TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)

017.50 - 017.56 TUBERCULOSIS OF THYROID GLAND UNSPECIFIED ORIGIN - TUBERCULOSIS OF THYROID GLAND TUBERCLE BACILLI NOT FOUND BY BACTERIOLOGICAL OR HISTOLOGICAL EXAMINATION BUT TUBERCULOSIS CONFIRMED BY OTHER METHODS (INOCULATION OF ANIMALS)

036.81 MENINGOCOCCAL OPTIC NEURITIS

140.0 - 149.9 MALIGNANT NEOPLASM OF UPPER LIP VERMILION BORDER - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE LIP AND ORAL CAVITY

160.0 - 160.9 MALIGNANT NEOPLASM OF NASAL CAVITIES - MALIGNANT NEOPLASM OF ACCESSORY

161.0 - 161.9 SINUS UNSPECIFIED MALIGNANT NEOPLASM OF GLOTTIS - MALIGNANT NEOPLASM OF LARYNX UNSPECIFIED

170.1 MALIGNANT NEOPLASM OF BONES OF SKULL AND FACE EXCEPT MANDIBLE

170.2 MALIGNANT NEOPLASM OF MANDIBLE

171.0 MALIGNANT NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK

171.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF CONNECTIVE AND OTHER SOFT TISSUE

172.1 MALIGNANT MELANOMA OF SKIN OF LIP

172.2 MALIGNANT MELANOMA OF SKIN OF EYELID INCLUDING CANTHUS

172.3 MALIGNANT MELANOMA OF SKIN OF EAR AND EXTERNAL AUDITORY CANAL

172.4 MALIGNANT MELANOMA OF SKIN OF OTHER AND UNSPECIFIED PARTS OF FACE

172.5 MALIGNANT MELANOMA OF SKIN OF SCALP AND NECK

176.2 KAPOSI'S SARCOMA PALATE

176.8 KAPOSI'S SARCOMA OTHER SPECIFIED SITES

190.0 - 190.9 MALIGNANT NEOPLASM OF EYEBALL EXCEPT CONJUNCTIVA CORNEA RETINA AND CHOROID - MALIGNANT NEOPLASM OF EYE PART UNSPECIFIED

193 MALIGNANT NEOPLASM OF THYROID GLAND

194.1 MALIGNANT NEOPLASM OF PARATHYROID GLAND

195.0 MALIGNANT NEOPLASM OF HEAD FACE AND NECK

196.0 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF HEAD FACE AND NECK

196.8 SECONDARY AND UNSPECIFIED MALIGNANT NEOPLASM OF LYMPH NODES OF MULTIPLE SITES

198.5 SECONDARY MALIGNANT NEOPLASM OF BONE AND BONE MARROW

198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES

200.01 RETICULOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

200.11 LYMPHOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

200.21 BURKITT'S TUMOR OR LYMPHOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

200.31 MARGINAL ZONE LYMPHOMA,LYMPH NODES OF HEAD, FACE, AND NECK

200.41 MANTLE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK

200.51 PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK

200.61 ANAPLASTIC LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK

200.71 LARGE CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK

200.81 OTHER NAMED VARIANTS OF LYMPHOSARCOMA AND RETICULOSARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.01 HODGKIN'S PARAGRANULOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.11 HODGKIN'S GRANULOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.21 HODGKIN'S SARCOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.41 HODGKIN'S DISEASE LYMPHOCYTIC-HISTIOCYTIC PREDOMINANCE INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.51 HODGKIN'S DISEASE NODULAR SCLEROSIS INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.61 HODGKIN'S DISEASE MIXED CELLULARITY INVOLVING LYMPH NODES OF HEAD FACE AND NECK

201.71 HODGKIN'S DISEASE LYMPHOCYTIC DEPLETION INVOLVING LYMPH NODES OF HEAD FACE AND NECK

202.01 NODULAR LYMPHOMA INVOLVING LYMPH NODES OF HEAD FACE AND NECK

202.71 PERIPHERAL T CELL LYMPHOMA, LYMPH NODES OF HEAD, FACE, AND NECK

202.81 OTHER MALIGNANT LYMPHOMAS INVOLVING LYMPH NODES OF HEAD FACE AND NECK

210.2 - 210.9 BENIGN NEOPLASM OF MAJOR SALIVARY GLANDS - BENIGN NEOPLASM OF PHARYNX UNSPECIFIED

212.1 BENIGN NEOPLASM OF NASAL CAVITIES MIDDLE EAR AND ACCESSORY SINUSES

212.2 BENIGN NEOPLASM OF LARYNX

213.1 BENIGN NEOPLASM OF BONES OF SKULL AND FACE

213.2 BENIGN NEOPLASM OF LOWER JAW BONE

215.0 OTHER BENIGN NEOPLASM OF CONNECTIVE AND OTHER SOFT TISSUE OF HEAD FACE AND NECK

224.0 - 224.9 BENIGN NEOPLASM OF EYEBALL EXCEPT CONJUNCTIVA CORNEA RETINA AND CHOROID -BENIGN NEOPLASM OF EYE PART UNSPECIFIED

226 BENIGN NEOPLASM OF THYROID GLANDS

227.1 BENIGN NEOPLASM OF PARATHYROID GLAND

230.0 CARCINOMA IN SITU OF LIP ORAL CAVITY AND PHARYNX

231.0 CARCINOMA IN SITU OF LARYNX

234.0 CARCINOMA IN SITU OF EYE

235.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF MAJOR SALIVARY GLANDS

235.2 NEOPLASM OF UNCERTAIN BEHAVIOR OF LIP ORAL CAVITY AND PHARYNX

235.6 NEOPLASM OF UNCERTAIN BEHAVIOR OF LARYNX

238.1 NEOPLASM OF UNCERTAIN BEHAVIOR OF CONNECTIVE AND OTHER SOFT TISSUE

238.8 NEOPLASM OF UNCERTAIN BEHAVIOR OF OTHER SPECIFIED SITES

239.2 NEOPLASM OF UNSPECIFIED NATURE OF BONE SOFT TISSUE AND SKIN

240.9 GOITER UNSPECIFIED

245.0 ACUTE THYROIDITIS

246.2 CYST OF THYROID

246.3 HEMORRHAGE AND INFARCTION OF THYROID

246.8 OTHER SPECIFIED DISORDERS OF THYROID

252.8 OTHER SPECIFIED DISORDERS OF PARATHYROID GLAND

360.00 - 360.04 PURULENT ENDOPHTHALMITIS UNSPECIFIED - VITREOUS ABSCESS

360.11 - 360.19 SYMPATHETIC UVEITIS - OTHER ENDOPHTHALMITIS

368.10 - 368.15 SUBJECTIVE VISUAL DISTURBANCE UNSPECIFIED - OTHER VISUAL DISTORTIONS AND ENTOPTIC PHENOMENA

368.2 DIPLOPIA

368.30 BINOCULAR VISION DISORDER UNSPECIFIED

368.40 - 368.47 VISUAL FIELD DEFECT UNSPECIFIED - HETERONYMOUS BILATERAL FIELD DEFECTS

376.00 - 376.9 ACUTE INFLAMMATION OF ORBIT UNSPECIFIED - UNSPECIFIED DISORDER OF ORBIT

377.00 - 377.9 PAPILLEDEMA UNSPECIFIED - UNSPECIFIED DISORDER OF OPTIC NERVE AND VISUAL PATHWAYS

378.50 - 378.56 PARALYTIC STRABISMUS UNSPECIFIED - TOTAL OPHTHALMOPLEGIA

378.60 - 378.63 MECHANICAL STRABISMUS UNSPECIFIED - LIMITED DUCTION ASSOCIATED WITH OTHER CONDITIONS

378.71 - 378.73 DUANE'S SYNDROME - STRABISMUS IN OTHER NEUROMUSCULAR DISORDERS

378.81 - 378.86 PALSY OF CONJUGATE GAZE - INTERNUCLEAR OPHTHALMOPLEGIA

379.40 - 379.49 ABNORMAL PUPILLARY FUNCTION UNSPECIFIED - OTHER ANOMALIES OF PUPILLARY FUNCTION

379.50 - 379.59 NYSTAGMUS UNSPECIFIED - OTHER IRREGULARITIES OF EYE MOVEMENTS

379.60 - 379.63 INFLAMMATION (INFECTION) OF POSTPROCEDURAL BLEB, UNSPECIFIED - INFLAMMATION (INFECTION) OF POSTPROCEDURAL BLEB, STAGE 3

379.91 PAIN IN OR AROUND EYE

379.92 SWELLING OR MASS OF EYE

471.0 - 471.9 POLYP OF NASAL CAVITY - UNSPECIFIED NASAL POLYP

478.11 - 478.19 NASAL MUCOSITIS (ULCERATIVE) - OTHER DISEASE OF NASAL CAVITY AND SINUSES

478.20 - 478.29 UNSPECIFIED DISEASE OF PHARYNX - OTHER DISEASES OF PHARYNX OR NASOPHARYNX

478.70 - 478.79 UNSPECIFIED DISEASE OF LARYNX - OTHER DISEASES OF LARYNX

682.1 CELLULITIS AND ABSCESS OF FACE

682.2 CELLULITIS AND ABSCESS OF NECK

784.1 HEADACHE

784.2 THROAT PAIN

784.3 SWELLING MASS OR LUMP IN HEAD AND NECK

784.4 APHASIA

784.40 - 784.49 VOICE AND RESONANCE DISORDER, UNSPECIFIED - OTHER VOICE AND RESONANCE DISORDERS

784.51 - 784.59 DYSARTHRIA - OTHER SPEECH DISTURBANCE

784.7 EPISTAXIS

784.8 HEMORRHAGE FROM THROAT

784.92 JAW PAIN

793.0 NONSPECIFIC (ABNORMAL) FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF SKULL AND HEAD

870.3 PENETRATING WOUND OF ORBIT WITHOUT FOREIGN BODY

870.4 PENETRATING WOUND OF ORBIT WITH FOREIGN BODY

V10.02 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF OTHER AND UNSPECIFIED PARTS OF ORAL CAVITY AND PHARYNX

V10.21 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF LARYNX

V10.22 PERSONAL HISTORY OF MALIGNANT NEOPLASM OF NASAL CAVITIES MIDDLE EAR AND ACCESSORY SINUSES

Diagnoses that Support Medical Necessity N/A

ICD-9 Codes that DO NOT Support Medical Necessity XX000 Not Applicable

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity N/A

General Information

Documentations Requirements

The documentation of the study requires a formal written report, with clear identifying demographics, the name of the interpreting provider, reason for the test, and interpretive report and copies of all images obtained. The computerized data with image reconstruction should also be maintained.

The medical record must contain documentation, including a written or electronic request for the procedure which fully supports the medical necessity of the procedure performed. This documentation includes, but is not limited

to relevant medical history, physical examination, diagnosis (if known), pertinent signs and symptoms and results of pertinent diagnostic tests and/or procedures. This entire documentation-not just the test report or the findings/diagnosis on the order, must be made available to Medicare upon request.

When a CT scan and MRI are performed on the same day for the same anatomical area, the medical record must clearly reflect the medical necessity for performing both tests.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s

order for the study. The physician must state the clinical indication/medical necessity for the study in his order for

the test.

Appendices

Utilization Guidelines

In general, it is not medically necessary to perform myelography, CT examinations, and MRI examinations for evaluation of the same condition on the same day. The medical record should document the necessity for evaluations in addition to a MRI.

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Sources of Information and Basis for Decision

American College of Radiology (2010). Practice guideline for communication of diagnostic imaging findings. Retrieved from http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines.aspx

American College of Radiology-American Society of Neuroradiology(2007). Practice guideline for he performance of magnetic resonance imaging (MRI) of the head and neck. Retrieved from http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines.aspx

American College of Radiology. (2003). ACR Practice Guideline for Performing and Interpreting Magnetic Resonance Imaging (MRI). (1)(1) 31-35.

Cummings. (2005). Otolaryngology: Head and Neck Surgery, 4th ed. Mosby

Illustrated Guide to Diagnostic Tests (2nd ed). Diagnostic procedures. Springhouse Corp., PA. Langford, R. & Thompson, J. (2000). Mosby’s handbook of diseases, 2nd ed. Mosby, St. Louis, MO.

Wong, W. (2002). MR Imaging of the lower face and salivary glands. UCSD Neuroradiology Teaching File Database.Retrieved from the World Wide Web on November 4, 2002, at http://spinwarp.ucsd.edu/NeuroWeb/.

Wong, W. (2002). Deep spaces, paranasal sinuses, and nasopharynx. UCSD Neuroradiology Teaching File Database. Retrieved from the World Wide Web on November 4, 2002, at http://spinwarp.ucsd.edu/NeuroWeb/.

Advisory Committee Meeting Notes This Local Coverage Determination (LCD) does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this LCD was developed in cooperation with advisory groups, which includes representatives from numerous societies.

Start Date of Comment Period

End Date of Comment Period

Start Date of Notice Period 05/01/2011

Revision History Number 4

Revision History Explanation Revision Number:4 Start Date of Comment Period:N/A

Start Date of Notice Period:10/01/2011

Revised Effective Date: 07/07/2011

LCR A2011-080

September 2011 Connection

Explanation of Revision: The Limitations section of the LCD has been revised to update language surrounding the coverage of MRI in patients with implantable pacemakers. CMS issued new language in the NCD for Pacemakers through Change Request 7441, transmittals 134 and 2293. These revisions are effective for claims processed on or after September 26, 2011 for dates of service on or after July 7, 2011.

Revision Number:3

Start Date of Comment Period:N/A

Start Date of Notice Period:05/01/2011 Revised Effective Date: 02/24/2011

LCR A2011-036

April 2011 Bulletin

Explanation of Revision: Under the “Documentation Requirements” section of the LCD, verbiage was updated to be in line with the guidelines used to develop the LCD. In addition, references were updated under the “Sources of Information and Basis for Decision” section of the LCD. These revisions are effective for dates of service on or after 04/05/2011. Under the “Indications and Limitations” section of the LCD, language was added according to instructions outlined in Change Request 7296, related to the National Coverage Determination (NCD) 220.2, Transmittal 132, dated 3/4/2011. Revisions related to CR 7296 will be effective for claims processed on or after 04/04/2011, for dates of service on or after 02/24/2011.

Revision Number:2

Start Date of Comment Period:N/A Start Date of Notice Period:10/01/2010 Revised Effective Date: 10/01/2010

LCR A2010-050

September 2010 Bulletin

Explanation of Revision: Annual 2011 ICD-9-CM-Update. Added diagnosis code 784.92 and descriptor. The effective date of this revision is based on date of service.

Revision Number:1

Start Date of Comment Period:N/A Start Date of Notice Period:10/01/2009 Revised Effective Date: 10/01/2009

LCR A2009-081

September 2009 Bulletin

Explanation of Revision: Annual 2010 ICD-9-CM Update. Deleted diagnosis 784.5 and replaced with diagnosis code range 784.51-784.59. Revised descriptor for 784.40-784.49 and 793.0. The effective date of this revision is based on date of service.

Revision Number:Original

Start Date of Comment Period:N/A Start Date of Notice Period:12/04/2008 Revised Effective Date:02/16/2009

LCR A2009-034FL

December 2008 Bulletin

This LCD consolidates and replaces all previous policies and publications on this subject by the fiscal intermediary predecessors of First Coast Service Options, Inc. (COSVI and FCSO).

For Florida (00090) this LCD (L28905) replaces LCD L13786 as the policy in notice. This document (L28905) is effective on 02/16/2009.

08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update. 8/1/2010 - The description for Bill Type Code 12 was changed

8/1/2010 - The description for Bill Type Code 13 was changed 8/1/2010 - The description for Bill Type Code 14 was changed 8/1/2010 - The description for Bill Type Code 21 was changed 8/1/2010 - The description for Bill Type Code 22 was changed 8/1/2010 - The description for Bill Type Code 23 was changed 8/1/2010 - The description for Bill Type Code 75 was changed 8/1/2010 - The description for Bill Type Code 85 was changed

8/1/2010 - The description for Revenue code 0320 was changed

8/1/2010 - The description for Revenue code 0321 was changed 8/1/2010 - The description for Revenue code 0322 was changed 8/1/2010 - The description for Revenue code 0323 was changed 8/1/2010 - The description for Revenue code 0324 was changed 8/1/2010 - The description for Revenue code 0329 was changed 8/1/2010 - The description for Revenue code 0610 was changed 8/1/2010 - The description for Revenue code 0611 was changed 8/1/2010 - The description for Revenue code 0612 was changed 8/1/2010 - The description for Revenue code 0614 was changed 8/1/2010 - The description for Revenue code 0615 was changed 8/1/2010 - The description for Revenue code 0616 was changed 8/1/2010 - The description for Revenue code 0618 was changed 8/1/2010 - The description for Revenue code 0619 was changed

09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.

Reason for Change