Monday, March 6, 2017

CPT 75571 - 75574

CPT/HCPCS Codes  Group 1 Codes:

75572 Ct hrt w/3d image
75573 Ct hrt w/3d image congen
75574 Ct angio hrt w/3d image


Group 2 Codes:

75571 Ct hrt w/o dye w/ca test


Coverage Indications, Limitations, and/or Medical Necessity

Indications

As an alternative to invasive coronary angiography following a stress test that is equivocal or suspected to be inaccurate.

Instead of myocardial perfusion imaging in the evaluation of coronary artery disease in those patients who have moderate pre-test probability of disease based on clinical risk factors and abnormal diagnostic studies, not symptoms alone.

To evaluate the cause of symptoms in patients with known coronary artery disease.

Assessment of suspected congenital anomalies of coronary circulation or great vessels.

Assessment of coronary or pulmonary venous anatomy for the procedures described below:

CTA of the coronary veins is indicated when imaging of the coronary venous anatomy is necessary for biventricular pacemaker lead insertion.

CTA of the pulmonary veins is indicated when imaging of the pulmonary vasculature is necessary for pulmonary vein catheter ablation procedures for atrial fibrillation.
Limitations

Since the majority of the clinical research utilized a 64-slice CT scanner it is the recommended equipment. However, the intent of this LCD is not to monitor equipment utilization.

The procedure must be performed under the direct supervision of and interpreted by a cardiologist or radiologist who meets the competency guidelines outlined by the published guidelines, ACCF/AHA Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance, or American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging.

NOT COVERED:

CPT 75571
Using 71275 or 76497
Screening tests are defined as those tests done in the absence of signs, symptoms, or presence of disease. The use of these procedures (75572, 75573, 75574 for coronary CT angiography) in patients without signs, symptoms or presence of disease is considered to be screening by this Contractor.

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.
999x Not Applicable

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

ICD-10 Codes that Support Medical Necessity


ICD-10 CODE DESCRIPTION

I20.1 - I20.9 - Opens in a new window Angina pectoris with documented spasm - Angina pectoris, unspecified
I25.10 - I25.119 - Opens in a new window Atherosclerotic heart disease of native coronary artery without angina pectoris - Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.41 - I25.739 - Opens in a new window Coronary artery aneurysm - Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.751 - I25.759 - Opens in a new window Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm - Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.761 - I25.810 - Opens in a new window Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm - Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.82 - I25.9 - Opens in a new window Chronic total occlusion of coronary artery - Chronic ischemic heart disease, unspecified
I48.0 - I48.92 - Opens in a new window Paroxysmal atrial fibrillation - Unspecified atrial flutter
Q20.0 - Q25.0 - Opens in a new window Common arterial trunk - Patent ductus arteriosus
Q25.3 - Q26.4 - Opens in a new window Supravalvular aortic stenosis - Anomalous pulmonary venous connection, unspecified
Q26.8 Other congenital malformations of great veins
R06.02 Shortness of breath
R07.2 Precordial pain
R94.30 - R94.39 - Opens in a new window Abnormal result of cardiovascular function study, unspecified - Abnormal result of other cardiovascular function study
Z01.810 Encounter for preprocedural cardiovascular examination

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