States Applicable to Alert:
Hawaii, Nevada, American Samoa, Guam, the Northern Mariana Islands, Northern and Southern California

Background Information:
Palmetto GBA has determined that the range of CPT codes, listed below, were not updated in the system correctly when submitted with ICD-9 diagnosis code 414.3 This diagnosis was added as a Secondary Diagnosis (valid when submitted with ICD-9 diagnosis code(s) V72.81 and/or V72.83) effective for dates of service on or after October 1, 2008. According to the policy update, ICD-9 diagnosis code 414.3 is a stand alone diagnosis for services with dates of service on or after October 1, 2008.

CPT codes listed below might have been denied in error when submitted with ICD-9 code 414.3 without V72.81 or V72.83 for dates of service on and after October 1, 2008.

Note: For HI/NV – LCD Policy number applicable in October 2008 was L27711. The policy number was changed to L28284 in February 2009 for standardization purposes only for J1.

Applicable CPT Codes:
93922 93924 93926 93931
93923 93925 93930 93990

Modifier:
N/A

Remark /Reason Codes:
50 - These are non-covered services because this is not deemed a 'medical necessity' by the payer.
N115 - This decision was based on a Local Medical Review Policy (LMRP) or Local Coverage Determination (LCD). An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd or if you do not have Web access, you may contact the contractor to request a copy of the LMRP/LCD.

MAC Action:
Palmetto GBA will identify claims with dates of service on or after October 1, 2008, which have been denied incorrectly for CPT Codes 93922, 93923, 93924, 93925, 93926, 93930, 93931 and 93990 when covered diagnosis 414.3 was indicated on the claim. After the system is updated a mass adjustment will be performed on services denied in error.

Mass adjustment was completed on  August 28, 2009. No claims were found for HI/NV. Four claims were found for NCA and four claims were found for SCA.

Provider Action:
No action is required.

Date Reported: July 8, 2009

Date Resolved: August 28, 2009