Tuesday, August 10, 2010

Low Osmolar Contrast Material Procedure code A4644, 70010, 72255 with covered DX

FI Payment for Low Osmolar Contrast Material (LOCM)

The LOCM is paid on a reasonable cost basis when rendered by a SNF to its Part B patients (in addition to payment for the radiology procedure) when it is used in one of the situations listed below.
The following HCPCS are used when billing for LOCM.

HCPCS Code Description (January 1. 1994, and later)

A4644 Supply of low osmolar contrast material (100-199 mgs of iodine);
A4645 Supply of low osmolar contrast material (200-299 mgs of iodine); or
A4646 Supply of low osmolar contrast material (300-399 mgs of iodine).

When billing for LOCM, SNFs use revenue code 0636. If the SNF charge for the radiology procedure includes a charge for contrast material, the SNF must adjust the charge for the radiology procedure to exclude any amount for the contrast material.

NOTE: LOCM is never billed with revenue code 0255 or as part of the radiology procedure.

The FI will edit for the intrathecal procedure codes and the following ICD-9-CM codes to determine if payment for LOCM is to be made. If an intrathecal procedure code is not present, or one of the ICD-9-CM codes is not present to indicate that a required medical condition is met, the FI will deny payment for LOCM. In these instances, LOCM is not covered and should not be billed to Medicare.

When LOCM Is Separately Billable and Related Coding Requirements

• In all intrathecal injections. HCPCS codes that indicate intrathecal injections are:
70010 70015 72240 72255 72265 72270 72285 72295
One of these must be included on the claim; or

   •
In intravenous and intra-arterial injections only when certain medical conditions are present in an outpatient. The SNF must verify the existence of at least one of the following medical conditions, and report the applicable ICD-9-CM diagnosis code(s) either as a principal diagnosis code or other diagnosis codes on the claim:
o
A history of previous adverse reaction to contrast material. The applicable ICD-9-CM codes are V14.8 and V14.9. The conditions which should not be considered adverse reactions are a sensation of heat, flushing, or a single episode of nausea or vomiting. If the adverse reaction occurs on that visit with the induction of contrast material, codes describing hives, urticaria, etc. should also be present, as well as a code describing the external cause of injury and poisoning, E947.8;
o
A history or condition of asthma or allergy. The applicable ICD-9-CM codes are V07.1, V14.0 through V14.9, V15.0, 493.00, 493.01, 493.10, 493.11, 493.20, 493.21, 493.90, 493.91, 495.0, 495.1, 495.2, 495.3, 495.4, 495.5, 495.6, 495.7, 495.8, 495.9, 995.0, 995.1, 995.2, and 995.3;
o
Significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmia, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension. The applicable ICD-9-CM codes are:

402.00
402.01
402.10
402.11
402.90
402.91
404.00
404.01
404.02
404.03
404.10
404.11
404.12
404.13
404.90
404.91
404.92
404.93
410.00
410.01
410.02
410.10
410.11
410.12
410.20
410.21
410.22
410.30
410.31
410.32
410.40
410.41
410.42
410.50
410.51
410.52
410.60
410.61
410.62
410.70
410.71
410.72
410.80
410.81
410.82
410.90
410.91
410.92
411.1
415.0
416.0
416.1
416.8
416.9
420.0
420.90
420.91
420.99
424.90
424.91
424.99
427.0
427.1
427.2
427.31
427.32
427.41
427.42
427.5
427.60
427.61
427.69
427.81
427.89
427.9
428.0
428.1
428.9
429.0
429.1
429.2
429.3
429.4
429.5
429.6
429.71
429.79
429.81
429.82
429.89
429.9
785.50
785.51
785.59

o Generalized severe debilitation. The applicable ICD-9-CM codes are 203.00, 203.01, all codes for dibetes mellitus, 518.81, 585, 586, 799.3, 799.4, and V46.1; or

o Sickle Cell disease. The applicable ICD-9-CM codes are 282.4, 282.60, 282.61, 282.62, 282.63, and 282.69.

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