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Hi All,
Reaching out for your guidance on the Noridian LCD L38613 for FFR studies where the only reimbursable diagnosis code listed in the Noridian LCD is R93.1 – Abnormal findings on diagnostic imaging of heart and coronary circulation. Per correct coding conventions, coders are to assign the confirmed/definitive diagnosis followed by any additional signs/symptoms codes that are identified and documented for a study OR the diagnosis code will be pulled from the indication for the study. In either case, the diagnosis code will be a specific “I” code regarding the findings on the FFR or on the CCTA, which will be CAD or Stenosis. Although CAD and Stenosis are abnormal findings on the CCTA and therefore justify usage of the R93.1 as the indication for the FFR study, usage of that generic code would not be normal convention. However, we could list the R93.1 as a secondary diagnosis and pull through both the “I” and “R” codes as the indication for the FFR. We are seeking your opinion on whether this would be compliant and subsequently reimbursable.
I’ve included the LCD and a clinical example of a CCTA with confirmed diagnosis of LAD Stenosis, ICD-10 code I25.10.
NORIDIAN LCD NUMBER L38613 ( https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38613&ver=11&bc=0)
I appreciate you taking the time to provide clarity and guidance and I know our cardiology group is most grateful as well for your expertise.
Reaching out for your guidance on the Noridian LCD L38613 for FFR studies where the only reimbursable diagnosis code listed in the Noridian LCD is R93.1 – Abnormal findings on diagnostic imaging of heart and coronary circulation. Per correct coding conventions, coders are to assign the confirmed/definitive diagnosis followed by any additional signs/symptoms codes that are identified and documented for a study OR the diagnosis code will be pulled from the indication for the study. In either case, the diagnosis code will be a specific “I” code regarding the findings on the FFR or on the CCTA, which will be CAD or Stenosis. Although CAD and Stenosis are abnormal findings on the CCTA and therefore justify usage of the R93.1 as the indication for the FFR study, usage of that generic code would not be normal convention. However, we could list the R93.1 as a secondary diagnosis and pull through both the “I” and “R” codes as the indication for the FFR. We are seeking your opinion on whether this would be compliant and subsequently reimbursable.
I’ve included the LCD and a clinical example of a CCTA with confirmed diagnosis of LAD Stenosis, ICD-10 code I25.10.
NORIDIAN LCD NUMBER L38613 ( https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38613&ver=11&bc=0)
I appreciate you taking the time to provide clarity and guidance and I know our cardiology group is most grateful as well for your expertise.