LCD Reference Article Response To Comments Article

Response to Comments: Ophthalmic Angiography (Fluorescein and Indocyanine Green) LCD L34426

A55314

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Source Article ID
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Article ID
A55314
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Ophthalmic Angiography (Fluorescein and Indocyanine Green) LCD L34426
Article Type
Response to Comments
Original Effective Date
09/08/2016
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Comments were received from one commenter regarding the coding of this LCD. There were several specific issues raised as noted below:

Response To Comments

Number Comment Response
1 Certain translations of ICD-9 codes covered in the retired ICD-9 version of the LCD (L31557) are not included as covered in the current LCD. Specifically, for coverage under CPT 92240, ICD-10 diagnosis codes H30.109, H30.119, H30.129, H30.139, H30.60, H35.60, H35.719, H35.729, and H35.739 make laterality reference to “unspecified eye”. These codes were not included in the LCD because correct coding procedures dictate that claims be coded to the highest level of specificity possible. CMS directives regarding ICD-10 coding support contractors in their decision not to cover ICD-10 diagnosis codes relating to unspecified anatomical structures in LCDs. Palmetto GBA will not add the ICD-10 codes for “unspecified eye” to this LCD.
2 For CPT 92240, H35.053 the code for bilateral eyes, was omitted while H35.051 and H35.052 are listed as covered. H35.053 as a covered ICD-10 diagnosis for CPT 92240 was previously added to the current LCD in response to a previous reconsideration request from the same provider. No further action is required.
3 For CPT 92240, H35.32 is not covered but the equivalent was covered in the retired version of the LCD but not included in the current LCD. H35.32 is listed as a covered diagnosis for CPT 92240 under Group 2 Codes. This code was previously added to the current LCD in response to a previous reconsideration request from the same provider. No further action is required.
4 For CPT 92235 coverage for all appropriate translations of ICD-9 diagnoses 362.03, 362.04, 362.05, and 362.06 are not included among the covered diagnoses. These codes were previously added to the current LCD in response to a previous reconsideration request from the same provider. No further action is required. Only the following translations that were requested for addition in the prior reconsideration request were not added to the current list of covered diagnoses: E08.311 E09.311 E10.311 E11.311 E13.311 E08.319 E09.319 E10.319 E11.319 E13.319 These codes all contain the description “unspecified diabetic retinopathy”. All other diagnosis codes for the same conditions with either nonproliferative diabetic retinopathy or proliferative diabetic retinopathy, graded as either mild, moderate or severe in their description are listed as covered diagnoses in the current LCD, there is no need to include these non-specific code for the same reason outlined in section A of this response.
5 Under Group 3: ICD-10 Codes that DO NOT Support Medical Necessity there is a conflict between the codes listed in this section and the covered codes in Group 1: ICD-10 Codes for Fluorescein Angiography. The list of non-covered codes in Group 3 should only apply to CPT 92240 Indocyanine Green Angiography. Palmetto GBA agrees with the commenter in this regard and will remove Group 3 from the LCD. It is adequate to list only covered diagnosis codes for each procedure in the LCD. All diagnosis codes not listed for a given CPT code should be assumed to be non-covered.
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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Updated On Effective Dates Status
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Keywords

  • Ophthalmic Angiography