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01/11/2017

CGS Updating LCD (L34175) Ophthalmic Angiography To Include Missing ICD-10 Codes

CGS Updating LCD (L34175) Ophthalmic Angiography To Include Missing ICD-10 Codes 

In December several OOS practices alerted us to a problem that had occurred in October when new ICD-10 codes were established. Several existing codes weren't copied over and included in the updated Ophthalmic Angiography LCD. In response, OOS sent an inquiry to CGS and got the missing codes added. The information below details the inquiry and response from CGS. If you have an questions or need further clarification, please contact the OOS office.

OOS Inquiry

I am writing to request an update to the LCD (L34175) Ophthalmic Angiography (Fluorescein and Indocyanine Green). There is an issue with the portion of the LCD that covers Indocyanine Green that I believe was not converted correctly when the October 1, 2016 update was made.

Specifically, the issue is with the ICD-10 Code H35.32. From October 1, 2015 to September 30, 2016, H35.32 was listed as one of the approved ICD-10 codes when billing for 92240.

On October 1, 2016 this code was not included in the new LCD. This code was deleted but should have been replaced with the series H35.3211-H35.3233. (prior to 10/1/2016, H35.32 was a 6-digit code due to the addition of “stage”)

Effective 10/1/2016 these diagnostic statements require 7-digit coding due to the addition of laterality AND stage. It was not replaced and updated just the old code was deleted.

Therefore, practices are currently being denied the ability to use Indocyanine Green for AMD when clearly it has been deemed covered and medically necessary in the past. We respectfully ask that this update be made as soon as possible and claims that have been denied be retroactively paid. Thank you very much for your consideration. We look forward to hearing from you.

CGS Response (received on Monday 2/13)

After review of your request and looking in the MCD database we did see that during the ICD-10 annual review the new codes for H35.32 were left off in error for 92240 in group three. Please allow 14 business days for this to be corrected and show the update in the MCD. Thank you for bringing this to our attention and if we can be of further assistance please let us know.

CGS clarified further when asked what to do about claims that were already filed.

If they would not mind requesting a re-opening or they can rebill in 14 business days that would be the fastest avenue. It can take awhile when requesting mass adjustments.