CMS Updates ECP ICD-9 and ICD-10 Coverage
- By admin aapc
- In Billing
- July 13, 2012
- Comments Off on CMS Updates ECP ICD-9 and ICD-10 Coverage
The Centers for Medicare & Medicaid Services (CMS) has expanded extracorporeal photopheresis (ECP) coverage for the treatment of bronchialitis obliterans syndrome (BOS) following lung allograft transplantation when processing claims with service dates on or after April 30. This policy change expands coverage only for when ECP is provided under a clinical research study that meets specific assessment requirements. Coverage criteria is outlined in publication 100-03, section 110.4 of the National Coverage Determination Manual.
According to July 10 transmittal 2494, which rescinds May 18 transmittal 2473, CPT® procedure code 36522 Photopheresis, extracorporeal is used for billing ECP. Effective April 30, 2012 coverage has expanded to include these ICD-9-CM codes:
- 996.83 Complications of transplanted heart
- 996.85 Complications of transplanted bone marrow
- 996.88 Complications of stem cell transplant
You can use the following ICD-9-CM diagnosis codes for BOS services following lung allograft transplantation:
- 996.84 Complications of transplanted lung
- 491.9 Unspecified chronic bronchitis
- 491.20 Obstructive chronic bronchitis without exacerbation
- 491.21 Obstructive chronic bronchitis with (acute) exacerbation
- 496 Chronic airway obstruction, not elsewhere classified
The following ICD-9-CM procedure code can be used for the new expanded coverage:
- 99.88 Therapeutic photopheresis
In addition to code 36522, you can apply the following ICD-9/ICD-10 codes for claims on or after April 30 for ECP for the treatment of BOS following lung allograft transplantation only when ECP is provided under a clinical research study, as outlined in section 190:
| ICD-9 Codes | Long Description | ICD-10 Codes | ICD-10 Description |
| 491.20 | Obstructive chronic bronchitis without exacerbation | J44.9 | Chronic obstructive pulmonary disease, unspecified |
| 491.21 | Obstructive chronic bronchitis with (acute) exacerbation | J44.1 | Chronic obstructive pulmonary disease with (acute) exacerbation |
| 491.9 | Unspecified chronic bronchitis | J42 | Unspecified chronic bronchitis |
| 496 | Chronic airway obstruction, not elsewhere classified | J44.9 | Chronic obstructive pulmonary disease, unspecified |
| 996.84 | Complications of transplanted lung | T86.810 | Lung transplant rejection |
| 996.84 | Complications of transplanted lung | T86.811 | Lung transplant failure |
| 996.84 | Complications of transplanted lung | T86.812 | Lung transplant infection (not recommended for ECP coverage) |
| 996.84 | Complications of transplanted lung | T86.818 | Other complications of lung transplant |
| 996.84 | Complications of transplanted lung | T86.819 | Unspecified complication of lung transplant |
| V70.7 | Examination of participant in clinical trial | Z00.6 | Encounter for examination for normal comparison and control in clinical research program (needed for CED) |
Report modifier Q0 Investigational clinical service provided in a clinical research study that is in an approved research study and use diagnosis code V70.7 and condition code 30 (FIs only) for these claims.
Source: Transmittal 2494
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