Wiki MUGA help

[jtb57chevy]

This may be a really dumb question but I've asked dumb questions before and survived

Muga is ordered for LV dysfunction, ICD 9 429.9. Patient's LV dysfunction has not been labeled heart failure yet, but physician wants MUGA to evaluate ejection fraction - last EF by echo was 38% - for potential AICD implant. Our local MAC's LCD states one of the covered indications for 78472 is evaluation of patients in whom an accurate measure of the ejection fraction is needed to make a determination of whether to implant a defibrillator or biventricular pacemaker, BUT 429.9 is not listed as a covered diagnosis on the LCD. Are we wrong to push this claim through as is or do we need to append the ABN modifier GZ (we did not obtain an ABN)?

Thanks for any and all help!

 

[RhondaJohnson]

If there is an LCD, and you do not have a payable diagnosis I would think you will need the -GZ. But I think I get what your saying, the LCD says that your indication is payable, but the ICD-9 isn't listed. You might want to email your carrier and say, "What's up with that?"