Noridian Retires Three LCDs, Revises Three
Noridian Administrative Services, LLC (NAS) announced earlier this month that it is retiring certain local coverage determinations (LCDs) and revising a few others.
Changes to LCDs made by the Part A/B Medicare Administrative Contractor (A/B MAC) apply to Alaska, Oregon, and Washington (jurisdiction 2) and Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming (jurisdiction 3).
The following LCDs are being retired for contractors 00821, 03102, 03302, 03502, 03202, 03402, and 03602:
|Medicare Coverage Database Number||Policy Name||Effective Date|
|L14447/L24282||Cardiac catheterization, diagnostic||June 1, 2009|
|L23793/L24284||Cardiology, interventional||June 1, 2009|
|L23878/L24330||Magnetic resonance angiography
(MRA) of the head and neck, chest,
abdomen and pelvis, lower extremities
|July 1, 2009|
Practices in jurisdiction 2 who submit claims to Noridian should verify that no new policies have replaced these retired LCDs and if they should follow national coverage determinations (NCD).
Pertinent LCD revisions for the same contractors are as follows:
|Medicare Coverage Database Number||Policy Name||Effective Date||Summary of Changes|
|L23846/L24295||Cytogenetic Studies||June 1, 2009||ICD-9-CM code 289.83 added|
|L23644/L24308||Genetic Testing||June 1, 2009||CPT code 83909 verbiage added regarding KRAS testing and Amsterdam II criteria expansion|
|L23737/L24332||Monitored Anesthesia Care||July 1, 2009||ICD-9-CM code 327.23 added|
|L24473/L24471||Non-covered Services||April 24, 2009||HCPCS Level II codes 0176T, 0177T, 0192T, 0197T, and 085T were removed|
“NAS has determined that sufficient literature support now exists to allow coverage for KRAS testing,” according to Deborah Grider, CPC, CPC-I, CPC-H, CPC-P, CEMC, COBGC, CPCD, CCS-P, vice president, strategic development, American Academy of Professional Coders (AAPC). “Its coverage is limited to use in patients with metastatic colorectal cancer for whom either cetuximab (Erbitux) or panitumumab (Vectibix) therapy is contemplated as being appropriate. Although there remain some unanswered questions concerning the role of ‘personalized medicine,’ it appears that there is sufficient sensitivity and specificity in the K-RAS testing to allow the decision to be made that use of either of the two drugs noted above would be inappropriate if the KRAS mutation is identified.” CPT® code 83909 Molecular diagnostics; separation and identification by high resolution technique (eg, capillary electrophoresis), each nucleic acid preparation is added to the LCD effective June 1, 2009. Coverage of KRAS testing is added effective June 1, 2009.
NAS is now allowing monitored anesthesia care (MAC) with diagnosis code 327.23 for obstructive sleep apnea in an adult or pediatric patient. “MAC requires careful and continuous evaluation of various vital physiologic functions and the diagnosis and treatment of any deviations,” Grider says. “This type of anesthesia can be provided by a variety of qualified anesthesia personnel.”
The following codes, taken off the non-covered list, will most likely be carrier priced, since there are no RVUs associated with the Category III codes:
0176T Transluminal dilation of aqueous outflow canal; without retention of device or stent
0177T Transluminal dilation of aqueous outflow canal; with retention of device or stent
0192T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach
0197T Intra-fraction localization and tracking of target or patient motion during delivery of radiation therapy (eg, 3D positional tracking, gating, 3D surface tracking), each fraction of treatment
- 0085T Multivariate analysis of patient-specific finding with quantifiable computer probability assessment, including report
Retired LCDs appear under the Coverage/MR menu tab on the Noridian Web site.
The following draft LCDs have been posted to the Noridian Admininistrative Web site under the Coverage menu tab:
DL24473 Non-covered Services (for Arizona, Montana, North Dakota, South Dakota, Utah, and Wyoming)
DL24471 Non-covered Services (for Alaska, Oregon, and Washington)
DL16684 Injection of the Spinal Canal (for Alaska, Oregon, and Washington)
Noridian is accepting comments on these draft LCDs until Aug. 31, 2009.