L29265-LCD

LCD/NCD Portal

Local Coverage Determination (LCD) for Pulmonary Diagnostic Services (L29265)

Contractor Information

Contractor Name First Coast Service Options, Inc.

Contractor Number 09102

Contractor Type MAC - Part B

LCD Information

Document Information

LCD ID Number L29265

LCD Title Pulmonary Diagnostic Services

Contractor's Determination Number PULMDIAGSVCS

Primary Geographic Jurisdiction Florida

Oversight Region Region IV

AMA CPT/ADA CDT Copyright Statement

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 02/02/2009 Original Determination Ending Date

Revision Effective Date

For services performed on or after 01/01/2012 Revision Ending Date

CMS National Coverage Policy

Language quoted from CMS National Coverage Determination (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 represent quotation from one or more of the following CMS sources: N/A

Indications and Limitations of Coverage and/or Medical Necessity

Medicare will consider pulmonary diagnostic tests medically necessary for the indications outlined below. It is expected the provider of services will follow a thoughtful, purposeful sequence in his/her selection of tests appropriate to the patient’s presenting complaint, medical history, physical examination, etc.

Indications

Pulmonary diagnostic services will be considered reasonable and medically necessary when

• Ordered by the patient’s treating physician for a specific medical problem; and

• When performed only by providers of pulmonary services or other providers who have specialized training and expertise in performing pulmonary diagnostic services.

The CMS Manual System, Pub. 100-08, Program Integrity Manual, Chapter 13, Section 5.1 (http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf outlines that “reasonable and necessary" services are "ordered and/or furnished by qualified personnel."

A qualified physician for this service/procedure is defined as follows: A) Physician is properly enrolled in Medicare.

B) Training and expertise must have been acquired within the framework of an accredited residency and/or fellowship program in the applicable specialty/subspecialty in the United States or must reflect equivalent education, training, and expertise endorsed by an academic institution in the United States and/or by the applicable specialty/subspecialty society in the United States.

All pulmonary diagnostic studies must be: (1) performed by a qualified physician, or (2) performed under the general supervision of a qualified physician by a technologist who has demonstrated minimum entry level competency by being credentialed by a recognized national credentialing body such as the National Board for Respiratory Care (NBRC). In addition to receiving credentialing by a recognized national credentialing body, qualified technologists must have a state license.

Examples of certification for pulmonary diagnostic testing by non-physician personnel include:

• Certified Pulmonary Function Technician (CPFT)

• Registered Pulmonary Function Technician (RPFT)

• Certified Respiratory Therapist (CRT)

• Registered Respiratory Therapist (RRT)

• Perinatal/Pediatric Care Specialist

In addition to credentialing requirements, a state license is required if mandated by the state/territory of the practicing clinician. In the absence of a state/territory licensing or credentialing process, documentation should be maintained by the supervising physician which demonstrates appropriate training of staff performing the services. This documentation should be available to Medicare upon request.

Limitations

The use of pulmonary diagnostic function testing as part of the routine clinical exam is not covered under the Medicare benefit. In instances where studies are recommended as part of a preoperative evaluation in a patient with no active pulmonary symptoms, the record must document the rationale for the study (i.e. long history of smoking, asbestos exposure, exposure to toxic drugs, etc). Studies performed in the absence of such documentation will be considered not reasonable and medically necessary.

Patient initiated spirometry (94014, 94015 and 94016) are non covered and will not be reimbursed.

Pulmonary Function Tests

PFTs measure two components of the respiratory system: the mechanical ability of the respiratory system to move air in and out of the lungs; and the effectiveness of the respiratory system in exchanging oxygen and carbon dioxide with the atmosphere. A PFT includes three possible components:

1. Spirometry (94010, 94060, 94070)

2. Lung Volume Determination (94250, 94726, 94727 and 94728)

Lung Volume tests cannot be measured directly using Spirometry because these volumes and capacities include air that cannot be expelled from the lungs. Lung Volume is generally determined in one of four ways:

1. Closed circuit helium equilibration

2. Open circuit nitrogen washout

3. Whole body plethysmography

4. Radiologic techniques

3. Diffusion Capacity Tests (94729)

The PFT will be considered medically necessary for the following conditions:

• Preoperative evaluation of the lungs and pulmonary reserve when:

- thoracic surgery will result in loss of functional pulmonary tissue (i.e., lobectomy) or

- patients are undergoing major thoracic and/or abdominal surgery and the physician has some reason to believe the patient may have a pre-existing pulmonary limitation (e.g., long history of smoking); or

- the patient’s pulmonary function is already severely compromised by other diseases such as chronic obstructive pulmonary disease (COPD).

• Initial diagnostic workup for the purpose of differentiating between obstructive and restrictive forms of chronic pulmonary disease. Obstructive defects (e.g., emphysema, bronchitis, asthma) occur when ventilation is

disturbed by an increase in airway resistance. Expiration is primarily affected. Restrictive defects (e.g., pulmonary fibrosis, tumors, chest wall trauma) occur when ventilation is disturbed by a limitation in chest expansion.

Inspiration is primarily affected.

• To assess the indications for and effect of therapy in diseases such as sarcoidosis, diffuse lupus erythematosus, and diffuse interstitial fibrosis syndrome.

• Evaluate patient’s response to a newly established bronchodilator anti-inflammatory therapy.

• To monitor the course of asthma and the patient’s response to therapy (i.e., especially to confirm home peak expiratory flow measurements).

• Evaluate patients who continue to exhibit increasing shortness of breath (SOB) after initiation of bronchodilator anti-inflammatory therapy.

• Initial evaluation for a patient that presents with new onset (within 1 month) of one or more of the following symptoms: shortness of breath, cough, dyspnea, wheezing, orthopnea, or chest pain.

• Initial diagnostic workup for a patient whose physical exam revealed one of the following: overinflation, expiratory slowing, cyanosis, chest deformity, wheezing, or unexplained crackles.

• Initial diagnostic workup for a patient with chronic cough. It is not expected that a patient would have a repeat spirometry without new symptomatology.

• Re-evaluation of a patient with or without underlying lung disease who presents with increasing SOB (from previous evaluation) or worsening cough and related qualifying factors such as abnormal breath sounds or decreasing endurance to perform Activities of Daily Living (ADL’s).

• To establish baseline values for patients being treated with pulmonary toxic regimens (e.g., Amiodarone).

• To monitor patients being treated with pulmonary toxic regimens when any new respiratory symptoms (e.g., exertional dyspnea, non-productive cough, pleuritic chest pain) may suggest the possibility of pulmonary toxicity.

• To evaluate cystic fibrosis patients with pulmonary manifestations.

It is expected that procedure code 94070 will only be performed to make an initial diagnosis of asthma.

Also, it is expected that procedure code 94060 be utilized during the initial diagnostic evaluation of a patient. Once it has been determined that a patient is sensitive to bronchodilators, repeat bronchospasm evaluation is usually not medically necessary, unless one of the following circumstances exist:

(1) a patient is exhibiting an acute exacerbation and a bronchospasm evaluation is being performed to determine if the patient will respond to bronchodilators;

(2) the initial bronchospasm evaluation was negative for bronchodilator sensivity and the patient presents with new symptoms which suggest the patient has a disease process which may respond to bronchodilators; or

(3) the initial bronchospasm evaluation was not diagnostic due to lack of patient effort. Repeat spirometries performed to evaluate patients’ response to newly established treatments, monitor the course of asthma/COPD, or evaluate patients continuing with symptomatology after initiation of treatment should be utilized with procedure code 94010.

In addition, it is not expected that a pulse oximetry (procedure code 94760 or 94761) for oxygen saturation would routinely be performed with spirometry. Pulse oximetry is considered medically necessary when the patient has a condition resulting in hypoxemia and there is a need to assess the status of a chronic respiratory condition, supplemental oxygen and/or a therapeutic regimen (e.g., acute symptoms).

Usually during an initial evaluation, there is no reason to obtain a spirometry after the administration of bronchodilators in patients who have normal spirometry, normal flow volume loop and normal airway resistance unless there is reason to believe (e.g., symptoms, exam) that a patient has underlying lung disease.

The residual volume (RV) cannot be measured by spirometry because this includes air that cannot be expelled from the lungs, and, therefore, is determined by subtracting the expiratory reserve volume (ERV) from the functional residual capacity (FRC). The FRC cannot be measured by simple spirometry either; therefore, procedure code 94726 or 94727 will be performed when the RV and FRC need to be determined.

The Maximum Voluntary Ventilation (MVV; procedure code 94200) is a determination of the liters of air that a person can breathe per minute by a maximum voluntary effort. This test measures several physiologic phenomena occurring at the same time. The results and success of this test are effort dependent, therefore, routine performance of this test is not recommended, except in cases such as: pre-operative evaluation, neuromuscular weakness, upper airway obstruction, or suspicion of Chest Bellows disease.

The Respiratory Flow Volume Loop (procedure code 94375) is used to evaluate the dynamics of both large and medium size airways. This test is more useful than the conventional spirogram. The procedure is the same for spirometry except for the addition of a maximal forced inspiration at the end of the force expiratory measures.

Pulmonary Stress Testing (94620, 94621)

The pulmonary stress testing procedures range from simple to complex. The simple procedure (Stage 1) consists of BP, ECG, and ventilation measurements at timed increments during exercise. The complex procedure includes Stage 2 and Stage 3. Stage 2 involves all of Stage 1 measurements in addition to the mixed venous CO2 tension (production) by means of rebreathing technique and O2 uptake. Stage 3 requires the following: (a) blood gas sampling and analysis, (b) an indwelling catheter is inserted into the brachial or radial artery, and (c) in addition to Stage 2 tests, measurements for cardiac output, alveolar ventilation, ratio of dead space to tidal volume, alveolar-arterial O2 tension difference, venous admixture ratio and lactate levels are determined.

Exercise testing is done to evaluate functional capacity and to assess the severity and type of impairment of existing as well as undiagnosed conditions. The Pulmonary Stress Test will be considered medically necessary for the following conditions:

• To determine whether the patient’s exercise intolerance is related to pulmonary disease, cardiac disease, or due to lack of conditioning or poor effort.

• Initial diagnostic workup when symptoms (generally dyspnea) are out of proportion to findings on static function (spirometry, lung volume, diffusion capacity).

• Detection of interstitial lung disease (fibrosis) or exercise-induced broncho-spasm which are only manifested by exercise.

• Evaluate patient’s response to a newly established pulmonary treatment regimen.

The majority of clinical problems can be assessed during the simple procedures included in Stage 1, and should be completed before more complex tests are performed. Abnormal results indicate that more precise information

is required through more complex Stage 2 protocols. If Stage 3 protocols are implemented, arterial blood analysis is necessary. In 75% of patients, Stage 1 is sufficient. Oxygen titration can be done during graded exercise to determine the oxygen needs for improving exercise tolerance and increased functional capacity.

Absolute contraindications to exercise testing include:

• Acute febrile illness

• Pulmonary edema

• Systolic BP > 250mm Hg

• Diastolic BP > 120mm Hg

• Acute asthma attack

• Unstable angina

• Acute Myocarditis

Lung Compliance (94750)

Lung compliance measures the elastic recoil or stiffness of the lungs. It is more invasive than other PFTs, because the patient is required to swallow an esophageal balloon.

Compliance studies are performed only when all other PFTs give equivocal results, or the results require confirmation by additional data.

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.

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.

99999 Not Applicable

CPT/HCPCS Codes

94010 SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENT(S), WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION

94060 BRONCHODILATION RESPONSIVENESS, SPIROMETRY AS IN 94010, PRE- AND POST-BRONCHODILATOR ADMINISTRATION

94070 BRONCHOSPASM PROVOCATION EVALUATION, MULTIPLE SPIROMETRIC DETERMINATIONS AS IN 94010, WITH ADMINISTERED AGENTS (EG, ANTIGEN[S], COLD AIR, METHACHOLINE)

94200 MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION

94250 EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE)

94375 RESPIRATORY FLOW VOLUME LOOP

94620 PULMONARY STRESS TESTING; SIMPLE (EG, 6-MINUTE WALK TEST, PROLONGED EXERCISE TEST FOR BRONCHOSPASM WITH PRE- AND POST-SPIROMETRY AND OXIMETRY)

94621 PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OF CO2 PRODUCTION, O2 UPTAKE, AND ELECTROCARDIOGRAPHIC RECORDINGS)

94726 PLETHYSMOGRAPHY FOR DETERMINATION OF LUNG VOLUMES AND, WHEN PERFORMED, AIRWAY RESISTANCE

94727 GAS DILUTION OR WASHOUT FOR DETERMINATION OF LUNG VOLUMES AND, WHEN PERFORMED, DISTRIBUTION OF VENTILATION AND CLOSING VOLUMES

94728 AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY

94729 DIFFUSING CAPACITY (EG, CARBON MONOXIDE, MEMBRANE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

94750 PULMONARY COMPLIANCE STUDY (EG, PLETHYSMOGRAPHY, VOLUME AND PRESSURE MEASUREMENTS)

ICD-9 Codes that Support Medical Necessity

135 SARCOIDOSIS

162.0 - 162.9 MALIGNANT NEOPLASM OF TRACHEA - MALIGNANT NEOPLASM OF BRONCHUS AND LUNG UNSPECIFIED

197.0 SECONDARY MALIGNANT NEOPLASM OF LUNG

197.3 SECONDARY MALIGNANT NEOPLASM OF OTHER RESPIRATORY ORGANS

212.2 BENIGN NEOPLASM OF TRACHEA

212.3 BENIGN NEOPLASM OF BRONCHUS AND LUNG

231.2 CARCINOMA IN SITU OF BRONCHUS AND LUNG

277.02 CYSTIC FIBROSIS WITH PULMONARY MANIFESTATIONS

415.0 ACUTE COR PULMONALE

415.11 - 415.19 IATROGENIC PULMONARY EMBOLISM AND INFARCTION - OTHER PULMONARY EMBOLISM AND INFARCTION

446.20 HYPERSENSITIVITY ANGIITIS UNSPECIFIED

466.0 - 466.19 ACUTE BRONCHITIS - ACUTE BRONCIOLITIS DUE TO OTHER INFECTIOUS ORGANISMS

486 PNEUMONIA ORGANISM UNSPECIFIED

490 BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC 491.0 - 491.9 opens in new

window SIMPLE CHRONIC BRONCHITIS - UNSPECIFIED CHRONIC BRONCHITIS

492.0 - 492.8 EMPHYSEMATOUS BLEB - OTHER EMPHYSEMA

493.00 - 493.92 EXTRINSIC ASTHMA UNSPECIFIED - ASTHMA UNSPECIFIED WITH (ACUTE) EXACERBATION

494.0 - 494.1 BRONCHIECTASIS WITHOUT ACUTE EXACERBATION - BRONCHIECTASIS WITH

495.0 - 495.9 ACUTE EXACERBATION FARMERS' LUNG - UNSPECIFIED ALLERGIC ALVEOLITIS AND PNEUMONITIS

496 CHRONIC AIRWAY OBSTRUCTION NOT ELSEWHERE CLASSIFIED

500 COAL WORKERS' PNEUMOCONIOSIS

501 ASBESTOSIS

502 PNEUMOCONIOSIS DUE TO OTHER SILICA OR SILICATES

503 PNEUMOCONIOSIS DUE TO OTHER INORGANIC DUST

504 PNEUMONOPATHY DUE TO INHALATION OF OTHER DUST

505 PNEUMOCONIOSIS UNSPECIFIED

506.4 CHRONIC RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS

506.9 UNSPECIFIED RESPIRATORY CONDITIONS DUE TO FUMES AND VAPORS 508.0 - 508.9 opens in new ACUTE PULMONARY MANIFESTATIONS DUE TO RADIATION - RESPIRATORY CONDITIONS DUE TO UNSPECIFIED EXTERNAL AGENT

515 POSTINFLAMMATORY PULMONARY FIBROSIS

516.1 PULMONARY ALVEOLAR PROTEINOSIS

516.2 IDIOPATHIC PULMONARY HEMOSIDEROSIS

516.3 PULMONARY ALVEOLAR MICROLITHIASIS

516.30 - 516.37 IDIOPATHIC INTERSTITIAL PNEUMONIA, NOT OTHERWISE SPECIFIED - DESQUAMATIVE INTERSTITIAL PNEUMONIA

516.4 LYMPHANGIOLEIOMYOMATOSIS

516.5 ADULT PULMONARY LANGERHANS CELL HISTIOCYTOSIS

516.8 OTHER SPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHIES

516.9 UNSPECIFIED ALVEOLAR AND PARIETOALVEOLAR PNEUMONOPATHY

517.1 - 517.8 RHEUMATIC PNEUMONIA - LUNG INVOLVEMENT IN OTHER DISEASES CLASSIFIED ELSEWHERE

518.0 - 518.89 PULMONARY COLLAPSE - OTHER DISEASES OF LUNG NOT ELSEWHERE CLASSIFIED

519.11 - 519.19 ACUTE BRONCHOSPASM - OTHER DISEASES OF TRACHEA AND BRONCHUS

519.4 DISORDERS OF DIAPHRAGM

519.8 OTHER DISEASES OF RESPIRATORY SYSTEM NOT ELSEWHERE CLASSIFIED

780.51 INSOMNIA WITH SLEEP APNEA, UNSPECIFIED

780.53 HYPERSOMNIA WITH SLEEP APNEA, UNSPECIFIED

780.57 UNSPECIFIED SLEEP APNEA

786.2 ORTHOPNEA

786.3 APNEA

786.4 CHEYNE-STOKES RESPIRATION

786.5 SHORTNESS OF BREATH

786.6 TACHYPNEA

786.7 WHEEZING

786.09 RESPIRATORY ABNORMALITY OTHER

786.2 COUGH

786.30 HEMOPTYSIS, UNSPECIFIED

786.39 OTHER HEMOPTYSIS

793.11 - 793.19 SOLITARY PULMONARY NODULE - OTHER NONSPECIFIC ABNORMAL FINDING OF LUNG FIELD

799.1 RESPIRATORY ARREST

V58.83 ENCOUNTER FOR THERAPEUTIC DRUG MONITORING

V72.82 PRE-OPERATIVE RESPIRATORY EXAMINATION

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

Medical record documentation must indicate the medical necessity for performing the test. In addition, documentation that the service was performed, including the results of the pulmonary diagnostic tests, should be available. This information is normally found in the office notes, progress notes, history and physical, and/or hard copy of the test results.

If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in his order for the test.

Test results and interpretation must be correlated with the clinical presentation of the patient and documented in the medical records. The specific procedures performed must be used for decision making and not duplicative of information obtained. Therefore, documentation should support that the test results and interpretation were used for the treatment of a specific medical problem by the physician who ordered the services.

Appendices

Utilization Guidelines

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.

The frequency of testing (repeat testing) must be related to the patient’s clinical status and correlated to the severity of a specific diagnosis.

Sources of Information and Basis for Decision

Medical Encyclopedia: Pulmonary function tests. Retrieved 10/13/2003 from http://www.nlm.nih.gov/medlineplus/print/ency/article/003853.htm

Medicare Coverage Database

Murray and Nadel. (2000). Textbook of Respiratory Medicine (3rd ed.). W.B. Saunders Company.

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 10/01/2010

Revision History Number 6

Revision History Explanation Revision Number 6 Start Date of Comment Period:N/A

Start Date of Notice Period:01/01/2012 Revised Effective Date01/01/2012

LCR B2011-024

December 2011 Connection

Explanation of Revision: Annual 2012 HCPCS Update. CPT codes 93720, 93721, 93722, 94240, 94260, 94350,

94360, 94370, 94720, and 94725 were deleted and replaced with CPT codes 94726 – 94729. The effective date of this revision is based on date of service.

Revision Number:5

Start Date of Comment Period:N/A Start Date of Notice Period:10/01/2011

Revised Effective Date:10/01/2011

LCR B2011-101

September 2011 Connection

Explanation of Revision: Annual 2012 ICD-9-CM Update. Deleted diagnosis code range 516.0-516.9 and replaced it with diagnosis codes 516.0, 516.1, 516.2, (new diagnosis codes 516.30-516.37, 516.4, and 516.5), 516.8, and 516.9. New diagnosis code range 516.61-516.69 was not added to the LCD. Deleted diagnosis code 793.1 and replaced it with diagnosis code range 793.11-793.19. The effective date of this revision is based on date of service.

Revision Number:4

Start Date of Comment Period:N/A Start Date of Notice Period:07/01/2011 Revised Effective Date:06/14/2011

LCR B2011-086

June 2011 Connection

Explanation of Revision: Based on an outside request to clarify our current training statement outlined in this

LCD, language under the “Indications” section of the LCD has been deleted and replaced with a revised statement regarding the qualification and training. Revisions will be effective based on process date.

Revision Number:3

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

LCR B2010-071

September 2010 Update

Explanation of Revision: Annual 2011 ICD-9-CM Update. Deleted ICD-9-CM code 786.3. Added ICD-9-CM codes

786.30 and 786.39. The effective date of this revision is based on date of service

Revision Number:2

Start Date of Comment Period:N/A Start Date of Notice Period:12/01/2009 Original Effective Date:11/03/2009

LCR B2009- 105

November 2009 Update

Explanation of Revision: LCD revised to provide instructions for clinicians within MAC J9 that do not have an established credentialing/licensing process for clinicians who perform pulmonary diagnostic services. 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 B2009-098

September 2009 Update

Explanation of Revision: Annual 2010 ICD-9-CM Update. Revised descriptor for diagnosis code 793.1. 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:02/02/2009

LCR B2009-044FL

December 2008 Update

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

For Florida (00590) this LCD (L29265) replaces LCD L17725 as the policy in notice. This document (L29265) is effective on 02/02/2009.

08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.

09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update. 08/27/2011 - This policy was updated by the ICD-9 2011-2012 Annual Update. 11/21/2011 - The following CPT/HCPCS codes were deleted:

93720 was deleted from Group 1

93721 was deleted from Group 1

93722 was deleted from Group 1

94240 was deleted from Group 1

94260 was deleted from Group 1

94350 was deleted from Group 1

94360 was deleted from Group 1

94370 was deleted from Group 1

94720 was deleted from Group 1

94725 was deleted from Group 1

Reason for Change