Local Coverage Article Billing and Coding

Billing and Coding: Once in a Lifetime Abdominal Aortic Aneurysm (AAA) Screening Article

A55071

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Article Information

General Information

Article ID
A55071
Article Title
Billing and Coding: Once in a Lifetime Abdominal Aortic Aneurysm (AAA) Screening Article
Article Type
Billing and Coding
Original Effective Date
06/23/2016
Revision Effective Date
10/31/2019
Revision Ending Date
N/A
Retirement Date
N/A
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CMS National Coverage Policy

CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 110.2 and 110.3.2

Title XVIII of the Social Security Act, §1833(e)

Article Guidance

Article Text

Once in a lifetime abdominal aortic aneurysm (AAA) screening is only covered under certain specified conditions.

When billing for AAA screenings, the following ICD-10 codes should be billed:

* Z13.6 for the encounter for screening for cardiovascular disorders and either

** The most appropriate code for tobacco usage: Z87.891, F17.210, F17.211, F17.213, F17.218 and F17.219 OR

* Z84.89 for family history of other specified conditions

Note: CPT® code 76706 is the only ultrasound service that is payable for AAA screening under Medicare services. No other CPT®/HCPCS codes are covered.

Per the CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 110.2 and 110.3.2,

Payment may be made for a one-time ultrasound screening for AAA for beneficiaries who meet the following criteria:
(i) receives a referral for such an ultrasound screening from the beneficiary’s attending physician, physician assistant, nurse practitioner or clinical nurse specialist;
(ii) receives such ultrasound screening from a provider or supplier who is authorized to provide covered ultrasound diagnostic services;
(iii) has not been previously furnished such an ultrasound screening under the Medicare Program; and
(iv) is included in at least one of the following risk categories- 

(I) has a family history of abdominal aortic aneurysm;
(II) is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime; or
(III) is a beneficiary who manifests other risk factors in a beneficiary category recommended for screening by the United States Preventive Services Task Force regarding AAA, as specified by the Secretary of Health and Human Services, through the national coverage determination process.***


*For risk category (I) note that Z84.89 is an “other specified” code and requires that the condition be reflected in the medical record, therefore family history of abdominal aortic aneurysm must be documented in the medical record.
**For risk category (II)
***For risk category (III) USPST does not currently have any additional screening recommendations at B or above grade at this time.

Effective for services furnished on or after January 1, 2017, the following code, modifiers, and type of service (TOS) are used for AAA screening services:

CPT® code 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
Short Descriptor: Us abdl aorta screen AAA

Modifiers: TC, 26
TOS: 4
Bill Types: 12x, 13x, 22x, 23x, 71x, 73x, 85x

Coding Information

CPT/HCPCS Codes

Group 1

(1 Code)
Group 1 Paragraph

CPT® code 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) Short Descriptor: Us abdl aorta screen AAA.

Group 1 Codes
CodeDescription
76706 ULTRASOUND, ABDOMINAL AORTA, REAL TIME WITH IMAGE DOCUMENTATION, SCREENING STUDY FOR ABDOMINAL AORTIC ANEURYSM (AAA)

CPT/HCPCS Modifiers

Group 1

(2 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
CodeDescription
26 PROFESSIONAL COMPONENT: CERTAIN PROCEDURES ARE A COMBINATION OF A PHYSICIAN COMPONENT AND A TECHNICAL COMPONENT. WHEN THE PHYSICIAN COMPONENT IS REPORTED SEPARATELY, THE SERVICE MAY BE IDENTIFIED BY ADDING THE MODIFIER -26 TO THE USUAL PROCEDURE NUMBER OR THE SERVICE MAY BE REPORTED BY USE OF THE FIVE DIGIT MODIFIER CODE 09926.
TC TECHNICAL COMPONENT; UNDER CERTAIN CIRCUMSTANCES, A CHARGE MAY BE MADE FOR THE TECHNICAL COMPONENT ALONE; UNDER THOSE CIRCUMSTANCES THE TECHNICAL COMPONENT CHARGE IS IDENTIFIED BY ADDING MODIFIER 'TC' TO THE USUAL PROCEDURE NUMBER; TECHNICAL COMPONENT CHARGES ARE INSTITUTIONAL CHARGES AND NOT BILLED SEPARATELY BY PHYSICIANS; HOWEVER, PORTABLE X-RAY SUPPLIERS ONLY BILL FOR TECHNICAL COMPONENT AND SHOULD UTILIZE MODIFIER TC; THE CHARGE DATA FROM PORTABLE X-RAY SUPPLIERS WILL THEN BE USED TO BUILD CUSTOMARY AND PREVAILING PROFILES

ICD-10-CM Codes that Support Medical Necessity

Group 1

(8 Codes)
Group 1 Paragraph

When billing for AAA screenings, the following ICD-10 codes should be billed:

* Z13.6 for the encounter for screening for cardiovascular disorders and either
** The most appropriate code for tobacco usage: Z87.891, F17.210, F17.211, F17.213, F17.218 and F17.219 OR
* Z84.89 for family history of other specified conditions

Palmetto GBA acknowledges that no current ICD-10 diagnosis code specifically describes the circumstance “(II) is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime;” as noted in the CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 110.2 and 110.3.2.

When choosing the appropriate diagnosis code to describe a beneficiary who is a former smoker who meets the tobacco usage criteria for this benefit, ICD-10 diagnosis code Z87.891 can be used. In the case of a beneficiary who is a current smoker, choose the applicable code from F17.210, F17.211, F17.213, F17.218 or F17.219.

Group 1 Codes
CodeDescription
F17.210 Nicotine dependence, cigarettes, uncomplicated
F17.211 Nicotine dependence, cigarettes, in remission
F17.213 Nicotine dependence, cigarettes, with withdrawal
F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders
F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders
Z13.6 Encounter for screening for cardiovascular disorders
Z84.89 Family history of other specified conditions
Z87.891 Personal history of nicotine dependence

ICD-10-CM Codes that DO NOT Support Medical Necessity

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
071x Clinic - Rural Health
073x Clinic - Freestanding
085x Critical Access Hospital

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/31/2019 R7

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual. Under CMS National Coverage Policy added regulations. Under CPT/HCPCS Codes Group 1: Paragraph added the verbiage “CPT® code 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) Short Descriptor: Us abdl aorta screen AAA”. Under CPT/HCPCS modifiers Group 1: Codes added modifiers TC and 26.

05/24/2018 R6

Under Article Text added the registered trademark symbol to each of the CPT codes listed in this section. The word “of” was replaced with the word “for” in the third sentence. Verbiage from the CMS Internet Only Policy Manual was italicized throughout the section. Under Covered ICD-10 Codes – Group 1: Paragraph replaced the word “of” with the word “for’ in the second sentence. Punctuation was corrected as appropriate throughout the Article.

02/26/2018 R5 The Jurisdiction "J" Part A and Part B Contracts for Alabama (10111/10112), Georgia (10211/10212) and Tennessee (10311/10312) are now being serviced by Palmetto GBA. Effective 02/26/18, these 6 contract numbers are being added to this article. No coverage, coding or other substantive changes (beyond the addition of the 6 Part A and B contract numbers) have been completed in this revision.
01/01/2017 R4 Under Article Text and CPT/HCPCS Codes deleted HCPCS code G0389 and replaced with CPT code 76706. This revision is due to the 2017 Annual CPT/HCPCS Code Update and becomes effective 1/1/17.
10/06/2016 R3 Under Covered ICD-10 Codes Group1: Paragraph added the last two paragraphs.
09/26/2016 R2 Under Covered ICD-10 Codes-Group 1: Paragraph added ICD-10 code F17.210 to the statement indicated with two asterisks as it was inadvertently omitted.
09/26/2016 R1 Under Article Text, Covered ICD-10 Codes-Group 1: Paragraph and Covered ICD-10 Codes Group 1: Codes added the ICD-10 code Z87.891.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
10/22/2019 10/31/2019 - N/A Currently in Effect You are here
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Keywords

  • AAA
  • Abdominal Aortic Aneurysm
  • Aneurysm