Wiki CPT 78803 Cardiac Amyloidosis

[lcouto]

We are going to begin doing these studies and were trying to find payable ICD 10 codes.. Can someone please point me in the right direction to locate these. It would greatly be appreciated... Thank you

 

[SharonCollachi]

I'm not really clear on the thinking on this question. If someone has Cigna, for example, you need to look at Cigna's policy on it and see when it is covered. Someone else's coverage isn't going to help you for that patient.

For example, Evicore Health states:

78803 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographiic (SPECT). (Non-SPECT is 78800)
A9538 for the radiopharmaceutical
Indications may include:
 Individuals with heart failure and unexplained increase in left ventricular wall thickness.
 African-Americans over the age of 60 years with heart failure, unexplained or with increased left ventricular wall thickness (>12 mm).
 Individuals over the age of 60 years with unexplained heart failure with preserved ejection fraction.
 Individuals, especially elderly males, with unexplained neuropathy, bilateral carpal tunnel syndrome or atrial arrhythmias in the absence of usual risk factors, and signs/symptoms of heart failure.
 Evaluation of cardiac involvement in individuals with known or suspected familial amyloidosis.
 Diagnosis of cardiac ATTR in individuals with CMR or echocardiography consistent with cardiac amyloidosis.
 Individuals with suspected cardiac ATTR amyloidosis and contraindications to CMR such as renal insufficiency or an implantable cardiac device.

 

[lcouto]

I'm not really clear on the thinking on this question. If someone has Cigna, for example, you need to look at Cigna's policy on it and see when it is covered. Someone else's coverage isn't going to help you for that patient.

For example, Evicore Health states:

78803 Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); tomographiic (SPECT). (Non-SPECT is 78800)
A9538 for the radiopharmaceutical
Indications may include:
 Individuals with heart failure and unexplained increase in left ventricular wall thickness.
 African-Americans over the age of 60 years with heart failure, unexplained or with increased left ventricular wall thickness (>12 mm).
 Individuals over the age of 60 years with unexplained heart failure with preserved ejection fraction.
 Individuals, especially elderly males, with unexplained neuropathy, bilateral carpal tunnel syndrome or atrial arrhythmias in the absence of usual risk factors, and signs/symptoms of heart failure.
 Evaluation of cardiac involvement in individuals with known or suspected familial amyloidosis.
 Diagnosis of cardiac ATTR in individuals with CMR or echocardiography consistent with cardiac amyloidosis.
 Individuals with suspected cardiac ATTR amyloidosis and contraindications to CMR such as renal insufficiency or an implantable cardiac device.

I am so sorry... I should have clarified for Medicare...

 

[SharonCollachi]

The Medicare Coverage Database has two articles using the code 78803, and neither one lists accepted dx codes.

I think I would start with the indications shown above.

 

[lcouto]

The Medicare Coverage Database has two articles using the code 78803, and neither one lists accepted dx codes.

I think I would start with the indications shown above.

Thank you so much for your help!