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Wiki LCD clarification

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jules0024

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wilmington, IL
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Hi,
I am looking for clarification on the Medicare LCD articles.
They list Group codes. One with the CPT/HCPCs code and the other with diagnosis codes. The Article I'm looking at is A59105 (IVIG).
Do group 1 CPT codes only meet medical necessity with group 1 diagnosis codes and group 2 covers group 2? Can group 1 CPT meet medical necessity with group 2 diagnosis codes?

Thank you!
Julie
 
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It can differ from one LCD to the next- you really have to read the instructions closely to understand why they are separating CPTs, HCPCS, and dx into different groups. For A59105, it appears that the group 1 diagnoses are the off-label use diagnoses that they still consider to meet the LCD. They revised it to also list the diagnoses that meet necessity but aren't off-label use under group 2 diagnoses.

This article contains coding or other guidelines that complement the local coverage determination (LCD) for Off-Label Use of Intravenous Immune Globulin (IVIG). The use of IVIG for labeled indications is not addressed in this article.

The LCD and this article address off-label uses for IVIG. We define off-label as not in Medicare approved compendia or in the FDA label. However, for the convenience of providers, we have added a list of labeled and compendia approved diagnoses in the Group 2 section for ICD-10-CM Codes that Support Medical Necessity below.
 
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