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G0446 | PR INTENS BEHAVE THER CARDIO DX | HCPCS | Code 33871’s descriptor better describes the way the procedure is performed now. Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. |
83718 | LIPOPROTEIN, DIRECT MEASUREMENT_ HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) | HCPCS | Code 33871’s descriptor better describes the way the procedure is performed now. Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. |
82465 | HC CHOLESTEROL LEVEL W/DIRECT LDL | HCPCS | Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. |
80061 | TTH LIPID-SP | HCPCS | Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. |
83718 | LIPOPROTEIN, DIRECT MEASUREMENT_ HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) | HCPCS | Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. |
G0446 | PR INTENS BEHAVE THER CARDIO DX | HCPCS | Medicare Coverage of Screening for Heart Disease
There are two Medicare-covered preventative services for heart disease screening per national coverage determination (NCD) 210.11: “Cardiovascular Disease Screening Tests” and “Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).”
If you are a Medicare patient and don’t have apparent signs or symptoms of CVD, you are still covered once every five years for cardiovascular disease screening tests. These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. |
82465 | HC CHOLESTEROL LEVEL W/DIRECT LDL | HCPCS | These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. |
8006 | CT and CTA with Contrast | APC | These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. |
80061 | TTH LIPID-SP | HCPCS | These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. |
G0446 | PR INTENS BEHAVE THER CARDIO DX | HCPCS | These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. |
83718 | LIPOPROTEIN, DIRECT MEASUREMENT_ HIGH DENSITY CHOLESTEROL (HDL CHOLESTEROL) | HCPCS | These tests are reported using CPT® code:
80061 Lipid panel
This panel must include the following:
Cholesterol, serum, total (82465)
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) (83718)
ICD-10-CM code Z13.6 Encounter for screening for cardiovascular disorders supports 80061; however, other codes may apply, as well. To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. |
G0446 | PR INTENS BEHAVE THER CARDIO DX | HCPCS | To see Change Requests (CRs) specific to individual ICD-10 codes for screening for cardiovascular disorders, go to the Centers for Medicare & Medicaid Services’ (CMS) Medicare Coverage – General Information ICD-10 webpage. According to NCD 210.11, IBT for CVD is covered annually for Medicare patients “who are competent and alert at the time counseling is provided” and if the counseling is furnished “by a qualified primary care physician or other primary care practitioner in a primary care setting.” Coding for the CVD risk reduction visit includes HCPCS Level II G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes. To see CRs specific to individual ICD-10 codes for IBT for CVD, go to the CMS Medicare Coverage – General Information ICD-10 webpage. More Heart Smart Resources
You can find more heart conscious resource links in the weekly MLN Connects, some of them include:
Prove Your Heart Expertise
AAPC has two credentials that can help prove your know-how in cardiovascular coding. Go to AAPC’s Certified Cardiovascular and Thoracic Surgery Coder (CCVTC™) and Certified Interventional Radiology Cardiovascular Coder (CIRCC®) credential pages to find out more. |
00100 | ANESTH SALIVARY GLAND | CPT | This allows the procedure to be covered and the provider to be reimbursed. Current Procedural Terminology codes were first developed by the American Medical Association in the 1960s as a means for the medical field to use standardized terms to document procedures and services in medical records. There are just under 10,000 different 6-digit CPT codes ranging between 00100 and 99499. While the codes are comprised of six digits, two-digit modifying codes may also be added to provide more clarification on the specifics of a procedure or service. Two or more codes are sometimes needed to describe an entire procedure or services, as one code may only describe part of a procedure. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on. |
E1239 | Ped power wheelchair nos | HCPCS | The combined data can be used to perform analytics, case studies, forecasting, and number of other use-cases. Proposed Standards By HITSP
In June 2006, The Healthcare Information Technology Standards Panel (HITSP) published a list of proposed standards to promote a nationwide HIT infrastructure. Some of the basic HITSP standards are;
ICD-9-CM, CPT, HCPCS, ASTM E1239-04—Standard Practice for Description of Reservation/Registration-Admission, Discharge, Transfer, ICD-10-CM, ICD-10-PCS, HL7 V2. X (for messaging), HL7 V3 Clinical Document Architecture (CDA) for text reports, etc. This list of standards makes it pretty obvious that no single standard can provide all of the information needed within an EHR. |
0194 | Subacute | RC | Geneva: World Health Organization; 2014. Peden AE, Franklin RC, Mahony A, Barnsley P, Scarr J. Using a retrospective cross-sectional study to analyse unintentional fatal drowning in Australia: ICD-10 coding-based methodologies verses actual deaths. BMJ Open. 2017;7:e019407. |
0920 | Other Diagnostic Services - General Classification | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. |
0195 | Subacute | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. |
0920 | Other Diagnostic Services - General Classification | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. |
0195 | Subacute | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. |
0920 | Other Diagnostic Services - General Classification | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage and/ or death (infarction) of heart muscle tissue (myocardium). |
0195 | Subacute | RC | From Wikipedia, the free encyclopedia
Myocardial infarction Classification and external resources
Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). ICD-10 ICD-9 DiseasesDB MedlinePlus eMedicine MeSH
I21.-I22. 410 8664 000195 med/1567 emerg/327 ped/2520 D009203
Myocardial infarction (MI or AMI for acute myocardial infarction), commonly known as a heart attack, occurs when the blood supply to part of the heart is interrupted causing some heart cells to die. This is most commonly due to occlusion (blockage) of a coronary artery following the rupture of a vulnerable atherosclerotic plaque, which is an unstable collection of lipids (like cholesterol) and white blood cells (especially macrophages) in the wall of an artery. The resulting ischemia (restriction in blood supply) and oxygen shortage, if left untreated for a sufficient period of time, can cause damage and/ or death (infarction) of heart muscle tissue (myocardium). |
1745 | Thoracoscopic robotic assisted procedure | ICD | PMID 17141745. - World Health Organisation. (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organisation. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | For the procedure, we’d code 23140 for “excision or curretage of bone cyst or benign tumor, humerus; with autograft (includes obtaining the graft).” Since the procedure was completed but not fully successful, we’d add the -52 modifier, for reduced services, to the code, and we’d end up with 23140-52. Physical Status Modifier (for Anesthesia)
Anesthesia procedures have their own special set of modifiers, which are simple and correspond to the condition of the patient as the anesthesia is administered. These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | These codes are:
- P1 – a normal, healthy patient
- P2 – a patient with mild systemic disease
- P3 – a patient with severe systemic disease
- P4 – a patient with severe systemic disease that is a constant threat to life
- P5 – a moribund patient who is not expected to survive without the operation
- P6 – a declared brain-dead patient whose organs are being removed for donor purposes
As we said, these are relatively straightforward, but let’s look at an example that will also use some of the CPT modifiers we learned just a minute ago. Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. |
00216 | ANESTH HEAD VESSEL SURGERY | CPT | Let’s return to that angioplasty example. The patient needs to be anesthetized before undergoing this procedure, so we turn to the Anesthesia section of the CPT codebook and find the code 00216 for “vascular procedures.” Now, kidney problems notwithstanding, our patient is in good health, so we’d add the –P1 modifier to this anesthesia code, and end up with 00216-P1. Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
CPT modifiers are also used in ambulatory surgery centers (ASC). These hospital outpatient facilities specialize in procedures where the patient leaves the same day. Note that there may be some overlap or contradiction with the set of HCPCS modifiers, which we’ll cover in more depth later on. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | With appropriate training from an accredited education program, professional medical billers and certified medical coders navigate these issues every day as part of their workday routine. It is a rewarding career, and it is an essential part of the healthcare industry. Medical billing and medical coding are based on the Healthcare Common Procedural Coding System (HCPCS), the foundation of how medical claims are submitted to commercial health insurers and government healthcare programs. The Healthcare Portability and Protection Act of 1996 (HIPPA) mandated that all healthcare claims be reported using HCPCS. Medical billers ensure that all healthcare claims are compliant with HIPPA through the accurate application of medical codes based on the documentation in the patient’s medical record, and based on the standards established by HCPCS. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | It is a rewarding career, and it is an essential part of the healthcare industry. Medical billing and medical coding are based on the Healthcare Common Procedural Coding System (HCPCS), the foundation of how medical claims are submitted to commercial health insurers and government healthcare programs. The Healthcare Portability and Protection Act of 1996 (HIPPA) mandated that all healthcare claims be reported using HCPCS. Medical billers ensure that all healthcare claims are compliant with HIPPA through the accurate application of medical codes based on the documentation in the patient’s medical record, and based on the standards established by HCPCS. How HCPCS Codes are Used
The federal Centers for Medicare and Medicaid Services (CMS) oversees the definition and use of HCPCS codes. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | Medical billing and medical coding are based on the Healthcare Common Procedural Coding System (HCPCS), the foundation of how medical claims are submitted to commercial health insurers and government healthcare programs. The Healthcare Portability and Protection Act of 1996 (HIPPA) mandated that all healthcare claims be reported using HCPCS. Medical billers ensure that all healthcare claims are compliant with HIPPA through the accurate application of medical codes based on the documentation in the patient’s medical record, and based on the standards established by HCPCS. How HCPCS Codes are Used
The federal Centers for Medicare and Medicaid Services (CMS) oversees the definition and use of HCPCS codes. HCPCS are divided in two levels. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Portability and Protection Act of 1996 (HIPPA) mandated that all healthcare claims be reported using HCPCS. Medical billers ensure that all healthcare claims are compliant with HIPPA through the accurate application of medical codes based on the documentation in the patient’s medical record, and based on the standards established by HCPCS. How HCPCS Codes are Used
The federal Centers for Medicare and Medicaid Services (CMS) oversees the definition and use of HCPCS codes. HCPCS are divided in two levels. Level I codes are commonly referred to as CPT codes because they belong to the Current Procedural Terminology (CPT) administered by the American Medical Association (AMA). |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | NCCI was established to prevent fraud and abuse of the Medicare system by preventing improper payments for services. Medical billers with the proper training understand that HCPCS Level I codes are used to bill Medicare, a government health insurance program that covers 48 million Americans, who make up a large percentage of any healthcare facility’s patient population. Understanding the use of HCPCS Level I codes is essential for professional medical billers to obtain maximum, legal reimbursement for their employers. CMS reviews the guidelines the AMA uses to define CPT codes, then it establishes coding methodologies and policies that promote correct coding on a national scale. Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | Medical billers with the proper training understand that HCPCS Level I codes are used to bill Medicare, a government health insurance program that covers 48 million Americans, who make up a large percentage of any healthcare facility’s patient population. Understanding the use of HCPCS Level I codes is essential for professional medical billers to obtain maximum, legal reimbursement for their employers. CMS reviews the guidelines the AMA uses to define CPT codes, then it establishes coding methodologies and policies that promote correct coding on a national scale. Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. The system has been expanded to include claims submitted under the Outpatient Prospective Payment System (OPPS) and claims submitted by skilled nursing facilities (SNFs). |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | Understanding the use of HCPCS Level I codes is essential for professional medical billers to obtain maximum, legal reimbursement for their employers. CMS reviews the guidelines the AMA uses to define CPT codes, then it establishes coding methodologies and policies that promote correct coding on a national scale. Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. The system has been expanded to include claims submitted under the Outpatient Prospective Payment System (OPPS) and claims submitted by skilled nursing facilities (SNFs). HCPCS Codes and NCCI
Medical billers and medical coders need to be aware of the current guidance established by the NCCI when they submit claims to Medicare. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | CMS reviews the guidelines the AMA uses to define CPT codes, then it establishes coding methodologies and policies that promote correct coding on a national scale. Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. The system has been expanded to include claims submitted under the Outpatient Prospective Payment System (OPPS) and claims submitted by skilled nursing facilities (SNFs). HCPCS Codes and NCCI
Medical billers and medical coders need to be aware of the current guidance established by the NCCI when they submit claims to Medicare. While the guidelines are updated quarterly, a basic understanding of the use of HCPCS, and how they are meant to be used according to the NCCI, is essential to adapt to the ongoing changes in the healthcare industry. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | Because of the number of healthcare claims processed and paid by the Medicare Part B program, NCCI policies have been in place since 1996 to ensure that only appropriate claims are paid. The system has been expanded to include claims submitted under the Outpatient Prospective Payment System (OPPS) and claims submitted by skilled nursing facilities (SNFs). HCPCS Codes and NCCI
Medical billers and medical coders need to be aware of the current guidance established by the NCCI when they submit claims to Medicare. While the guidelines are updated quarterly, a basic understanding of the use of HCPCS, and how they are meant to be used according to the NCCI, is essential to adapt to the ongoing changes in the healthcare industry. Employers can be assured that professional medical billers and certified medical coders have this understanding after they have successfully completed a formal program of study offered by an accredited institution that teaches medical billing and medical coding. |
83036 | TTH AIC-SP | HCPCS | Category III contains provisional codes that describe tools or technologies under evaluation. In addition, HCPCS Level I (CPT) codes are also found in AMA. Different types of CPT codes are used in chemistry. For example, common CPT codes used in chemistry are CPT code 83036 for hemoglobin and CPT 83605 for lipase enzyme. CPT codes are a standard nomenclature for medical procedures and services. |
83605 | Lactic acid level | HCPCS | Category III contains provisional codes that describe tools or technologies under evaluation. In addition, HCPCS Level I (CPT) codes are also found in AMA. Different types of CPT codes are used in chemistry. For example, common CPT codes used in chemistry are CPT code 83036 for hemoglobin and CPT 83605 for lipase enzyme. CPT codes are a standard nomenclature for medical procedures and services. |
83036 | TTH AIC-SP | HCPCS | In addition, HCPCS Level I (CPT) codes are also found in AMA. Different types of CPT codes are used in chemistry. For example, common CPT codes used in chemistry are CPT code 83036 for hemoglobin and CPT 83605 for lipase enzyme. CPT codes are a standard nomenclature for medical procedures and services. CPT codes are used in medical billing. |
83605 | Lactic acid level | HCPCS | In addition, HCPCS Level I (CPT) codes are also found in AMA. Different types of CPT codes are used in chemistry. For example, common CPT codes used in chemistry are CPT code 83036 for hemoglobin and CPT 83605 for lipase enzyme. CPT codes are a standard nomenclature for medical procedures and services. CPT codes are used in medical billing. |
90838 | Psytx w pt w e/m 60 min | HCPCS | For Further Information
Users of Definitive Healthcare’s Billing Executive may search for ICD-9 and ICD-10 codes and DRG, CPT, and HCPCS codes. Schedule a free trial now to see how we can assist you in building awareness of diagnostic and procedure activity, insight into patient journeys, provider treatment trends, and advance payment analytics. Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
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PR 96 & CO 96 Denial Code and Action – Non-covered Charges
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15005 | SURG PREP OPEN WOUND ADDL 100 | HCPCS | For Further Information
Users of Definitive Healthcare’s Billing Executive may search for ICD-9 and ICD-10 codes and DRG, CPT, and HCPCS codes. Schedule a free trial now to see how we can assist you in building awareness of diagnostic and procedure activity, insight into patient journeys, provider treatment trends, and advance payment analytics. Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
Work Injury Claim Denied CO 19: Work Related injury/illness
PR 96 & CO 96 Denial Code and Action – Non-covered Charges
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90838 | Psytx w pt w e/m 60 min | HCPCS | Schedule a free trial now to see how we can assist you in building awareness of diagnostic and procedure activity, insight into patient journeys, provider treatment trends, and advance payment analytics. Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
Work Injury Claim Denied CO 19: Work Related injury/illness
PR 96 & CO 96 Denial Code and Action – Non-covered Charges
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15005 | SURG PREP OPEN WOUND ADDL 100 | HCPCS | Schedule a free trial now to see how we can assist you in building awareness of diagnostic and procedure activity, insight into patient journeys, provider treatment trends, and advance payment analytics. Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
Work Injury Claim Denied CO 19: Work Related injury/illness
PR 96 & CO 96 Denial Code and Action – Non-covered Charges
Leave a Reply |
90838 | Psytx w pt w e/m 60 min | HCPCS | Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
Work Injury Claim Denied CO 19: Work Related injury/illness
PR 96 & CO 96 Denial Code and Action – Non-covered Charges
Leave a Reply |
15005 | SURG PREP OPEN WOUND ADDL 100 | HCPCS | Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections. We have more than 10 years experience in US Medical Billing and hand-on experience in Web Management, SEO, Content Marketing & Business Development with Research as a special forte. 15005 CPT CODE: Know your codes
90838 CPT CODE: KNOW YOUR CODES
Work Injury Claim Denied CO 19: Work Related injury/illness
PR 96 & CO 96 Denial Code and Action – Non-covered Charges
Leave a Reply |
0209 | Other Inpatient | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0834 | Peritoneal Dialysis - Outpatient or Home - Maintenance - 100% | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0370 | Use of a drug to induce depression of consciousness by physician performing a procedure, each additional 15 minutes | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0381 | Blood and Blood Components - Packed Red Cells | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0624 | Medical/Surgical Supplies and Devices - Extension of 027x - FDA Investigational Devices | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0439 | Occupational Therapy - Other Occupational Therapy | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0819 | Acquisition of Body Components - Other Donor | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
0402 | Ultrasonic guidance for needle placement | RC | Search for a rare disease
Other search option(s)
Cone rod dystrophy
Cone rod dystrophies (CRDs) are inherited retinal dystrophies that belong to the group of pigmentary retinopathies. - Synonym(s): -
- Prevalence: 1-9 / 100 000
- Inheritance: Autosomal dominant or Autosomal recessive or X-linked recessive
- Age of onset: Childhood
- ICD-10: H35.5
- OMIM: 120970 300476 300834 303700 304020 600624 600977 601777 602093 603649 604116 604393 605549 608194 610283 610381 610478 612657 612775 613660 614500 615163 615374 615860 615973 616502
- UMLS: -
- MeSH: -
- GARD: 10790
- MedDRA: -
The prevalence of CRDs is estimated at 1 in 40,000. CRDs are characterized by retinal pigment deposits, visible on fundus examination, predominantly localized to the macular region. In contrast to typical retinitis pigmentosa (RP), also called the rod cone dystrophies (RCDs), resulting from the primary loss in rod photoreceptors and later followed by the secondary loss in cone photoreceptors, CRDs reflect the opposite sequence of events. |
A0428 | HC BLS NON EMERGENCY A0428 | HCPCS | Level II or HCPCS Modifiers
Level II or HCPCS modifiers consist of two characters— either Alphabets or Alphanumeric. It’s pertinent to mention here that these modifiers are updated by the Centre for Medicare & Medicaid Services(CMS). The HCPCS modifiers are used to provide additional information on specific items used to deliver non-physician services. Before forwarding to the payers, all of this information is represented in the format ‘HCPCS code modifier’. For instance, A0428-QN is used to represent “basic life support ambulance service, non-emergency transport, furnished by the provider of services.”
Here is the list of most commonly used HCPCS modifiers:
- AA- Anesthesia services performed by anesthesiologists. |
A0428 | HC BLS NON EMERGENCY A0428 | HCPCS | It’s pertinent to mention here that these modifiers are updated by the Centre for Medicare & Medicaid Services(CMS). The HCPCS modifiers are used to provide additional information on specific items used to deliver non-physician services. Before forwarding to the payers, all of this information is represented in the format ‘HCPCS code modifier’. For instance, A0428-QN is used to represent “basic life support ambulance service, non-emergency transport, furnished by the provider of services.”
Here is the list of most commonly used HCPCS modifiers:
- AA- Anesthesia services performed by anesthesiologists. - AD- Medical supervision by a physician, more than four concurrent anaesthesia procedures. |
A0428 | HC BLS NON EMERGENCY A0428 | HCPCS | The HCPCS modifiers are used to provide additional information on specific items used to deliver non-physician services. Before forwarding to the payers, all of this information is represented in the format ‘HCPCS code modifier’. For instance, A0428-QN is used to represent “basic life support ambulance service, non-emergency transport, furnished by the provider of services.”
Here is the list of most commonly used HCPCS modifiers:
- AA- Anesthesia services performed by anesthesiologists. - AD- Medical supervision by a physician, more than four concurrent anaesthesia procedures. - AH- Clinical Psychologist (CP) Services. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | The Healthcare Common Procedure Coding System (HCPCS) is a two-tiered system that includes Common Procedure Terminology, at Level I, which is usually referred to as CPT codes. More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. |
1996 | Daily Hospital Management Of Epidural Or Subarachnoid Continuous Drug Administration | HCPCS | More specialized codes are used for reporting services to Medicare and other payers at Level II. Since these codes do not have an equivalent in any other manual but the Center for Medicare and Medicaid Services HCPCS manual, these codes are referred to as HCPCS in the field, to differentiate them from the more universal CPT codes. The use of HCPCS for all medical transactions was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPPA). While HIPPA established a number of regulations governing the transmission of Protected Health Information (PHI), its enactment also mandated the use of the same codes across the industry to describe medical procedures. For this reason, both medical billers and medical coders need a solid understanding of how these codes are meant to be used, the kind of understanding that can only be gained through a formal education program of study. |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0360 | Each additional hr 1-8 hrs | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86821 | Lymphocyte culture mixed | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86822 | Lymphocyte culture primed | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0359 | Chemotherapy IV one hr initi | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86817 | HC HLA TYPING; DR/DQ, MULTIPLE ANTIGENS | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0362 | Each add sequential infusion | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
86813 | HC HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary. The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. |
G0358 | IV PUSH TECHNIQUE EACH ADD SUBSTANCE/DRUG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86816 | HC HLA TYPING DR/DQ SINGLE AG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0360 | Each additional hr 1-8 hrs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
38204 | PR MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86821 | Lymphocyte culture mixed | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
J9999 | Not otherwise classified, antineoplastic drugs | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0361 | Prolong chemo infuse>8hrs pu | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86812 | Immunologic analysis for autoimmune disease, A, B, or C, single antigen | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86822 | Lymphocyte culture primed | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0359 | Chemotherapy IV one hr initi | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
38230 | PR BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86817 | HC HLA TYPING; DR/DQ, MULTIPLE ANTIGENS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0363 | IRRIG IMPLANTED VENOUS ACESS DEVICE DRUG DEL SYS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
J9000 | INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0364 | HC BONE MARROW ASPIRATE & BIOPSY | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0362 | Each add sequential infusion | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
86813 | HC HLA TYPING; A, B, OR C, MULTIPLE ANTIGENS | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0357 | IV PUSH TECHNIQUE SINGLE/INIT SUBSTANCE/DRUG | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0356 | HORMONAL ANTINEOPLASTIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
G0355 | CHEMO ADMN SUBQ/IM NONHORMONAL ANTINEOPLASTIC | HCPCS | The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language. POLICY HISTORY3/25/2004: See policy "High-Dose Chemotherapy with Hematopoietic Stem Cell Support for Malignancies" prior to 3/25/2004, separate policy developed and aligned with BCBSA policy # 8.01.35 per approval by Medical Policy Advisory Committee (MPAC)
6/25/2004: Code Reference section completed
11/18/2004: Reviewed by MPAC; no changes
10/26/2005: Code Reference section updated: CPT-4 codes: 38230 added; HCPCS: G0355, G0356, G0357, G0358, G0359, G0360, G0361, G0362, G0363, G0364 added; J9000-J9999 deleted; ICD-9 Procedure 41.01, 41.09 added, "(harvest) of stem cells" added to Covered Codes: CPT-4 codes: 38204 86812, 86813, 86816, 86817, 86821, 86822 added; ICD-9 Procedure 41.02. 41.03 added to Non-Covered Codes
03/10/2006: Coding updated. CPT4/HCPCS 2006 revisions added to policy. 9/18/2007: Policy reviewed, no changes
12/20/2007: Coding updated per 2008 CPT/HCPCS revisions
1/06/2009: Policy reviewed. |
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