RETIRED LCD Reference Article Response To Comments Article

Response to Comments: Thrombolytic Agents

A58012

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Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
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General Information

Source Article ID
N/A
Article ID
A58012
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Thrombolytic Agents
Article Type
Response to Comments
Original Effective Date
04/09/2020
Revision Effective Date
N/A
Revision Ending Date
N/A
Retirement Date
12/14/2023
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Article Text

The following are the comment summaries and contractor responses for the Novitas Solutions Proposed Local Coverage Determination (LCD) (DL35428) Thrombolytic Agents, which was posted for comment on October 31, 2019 and presented at the Open Meeting on November 15, 2019. All comments were reviewed and incorporated into the final LCD where applicable.

Response To Comments

Number Comment Response
1

One commenter indicated that the way the policy is written requiring that thrombolytic treatment via transcatheter, intracoronary, and intracranial infusion be administered in an inpatient setting suggests that a patient admitted to the hospital, and ultimately determined to be observation status, from the emergency department with a pulmonary embolism (or some other diagnosis that requires lytics) would not be covered.

Thank you for your comment. The current active policy contains the language that is in question and was not changed with this revision. However, it was not the intention of Novitas to exclude Observation status; therefore, a clarification in the wording will be made to say “Thrombolytic treatment via transcatheter, intracoronary, and intracranial infusion will be considered reasonable and necessary per the indication section only when performed in facility based care”.

2

One commenter stated that Novitas failed to include Current Procedural Terminology (CPT) Code 37211 under Group 4 ICD-10 coverage conditions.

Thank you for your comment. Currently, the group 4 ICD-10 code paragraph states that Medicare is establishing the following limited coverage for CPT/HCPCS codes 37211*, 37212, 37213*, 37214*, J0350, J2993, J2995, J2997, J3101, and J3365. No change is warranted at this time.

3

One commenter stated that according to the narrative guidance, injection of thrombolytic agents is eligible for payment for several indications including “treatment of thrombosed vascular prosthetic devices, implants, and grafts”. This statement would apply to codes 37211, 37213, and 37214, which may be reported for de-clotting of a stenosed/occluded vascular stent. However, the Group 3 ICD-10 code section of the draft billing and coding article does not include ICD-10-CM diagnosis codes that represent all the conditions described in the LCD narrative. The commenter pointed out that the diagnosis codes in question are included in the Group 1 covered diagnosis code list for CPT code 36593. However, CPT 36593 only represents de-clotting of an implanted vascular access device or catheter. There are instances where restenosis/occlusion occurs in a stent and de-clotting would be reported with CPT codes 37211/37213/37214. Therefore, they respectfully request that the Group 3 covered code listed of the draft billing and coding article be revised to include the following diagnosis codes as covered for CPT codes 37211, 37213, and 37214: T82.818A - Embolism due to vascular prosthetic devices, implants and grafts, initial encounter, T82.818D - Embolism due to vascular prosthetic devices, implants and grafts, subsequent encounter, T82.818S - Embolism due to vascular prosthetic devices, implants and grafts, sequela, T82.868A - Thrombosis due to vascular prosthetic devices, implants and grafts, initial encounter, T82.868D - Thrombosis due to vascular prosthetic devices, implants and grafts, subsequent encounter and T82.868S - Thrombosis due to vascular prosthetic devices, implants and grafts, sequela.

Thank you for the comment. While this comment was not specific to the current revisions, Novitas acknowledges that the ICD-10 codes that are being requested support the covered indications in the related policy for CPT codes 37211, 37213 and 37214. Therefore, ICD-10 codes T82.818A, T82.818D, T82.818S, T82.868A, T82.868D and T82.868S will be added to ICD-10 code group 3 in the billing and coding article.

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Coding Information

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CPT/HCPCS Modifiers

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ICD-10-CM Codes that Support Medical Necessity

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

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Other Coding Information

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Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
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Revision History Information

Revision History Date Revision History Number Revision History Explanation
12/14/2023 R1
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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35428 - Thrombolytic Agents
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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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
12/14/2023 04/09/2020 - 12/14/2023 Retired You are here
04/03/2020 04/09/2020 - N/A Superseded View

Keywords

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