Draft Local Coverage Article Billing and Coding

Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease

DA58097

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Draft Article
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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Source Article ID
A58097
Draft Article ID
DA58097
Draft Article Title
Billing and Coding: Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease
Article Type
Billing and Coding
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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CMS National Coverage Policy

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Article Guidance

Article Text

The information in the Supplemental Instructions Article contains billing, coding, or other guidelines that complement the Noridian Local Coverage Determination LCD for Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease DL38615.

Procedure codes may be subject to National Correct Coding Initiative edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

As this service constitutes post-procedure analysis of a previously performed study (CCTA), the name and National Provider Identifier (NPI) of the referring/ordering physician that submitted imaging data for FFRct review must be reported on the claim.

An Advance Beneficiary Notice (ABN) of non-coverage may be used for services that are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30 for complete instructions.

The patient’s medical record must document all of the following:

  1. The clinical findings that led to the initial performance of the CCTA, and the CCTA must be fully reviewed before the performance of FFRct. (as evidenced by the submission of the Coronary Computed Tomographic Angiography Report).
  2. Description of symptoms consistent with stable ischemic heart disease.
  3. Body mass index.
  4. Fractional Flow Reserve analysis report.

Coding Information

CPT/HCPCS Codes

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(4 Codes)
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Group 1 Codes
CodeDescription
0501T NONINVASIVE ESTIMATED CORONARY FRACTIONAL FLOW RESERVE (FFR) DERIVED FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY DATA USING COMPUTATION FLUID DYNAMICS PHYSIOLOGIC SIMULATION SOFTWARE ANALYSIS OF FUNCTIONAL DATA TO ASSESS THE SEVERITY OF CORONARY ARTERY DISEASE; DATA PREPARATION AND TRANSMISSION, ANALYSIS OF FLUID DYNAMICS AND SIMULATED MAXIMAL CORONARY HYPEREMIA, GENERATION OF ESTIMATED FFR MODEL, WITH ANATOMICAL DATA REVIEW IN COMPARISON WITH ESTIMATED FFR MODEL TO RECONCILE DISCORDANT DATA, INTERPRETATION AND REPORT
0502T NONINVASIVE ESTIMATED CORONARY FRACTIONAL FLOW RESERVE (FFR) DERIVED FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY DATA USING COMPUTATION FLUID DYNAMICS PHYSIOLOGIC SIMULATION SOFTWARE ANALYSIS OF FUNCTIONAL DATA TO ASSESS THE SEVERITY OF CORONARY ARTERY DISEASE; DATA PREPARATION AND TRANSMISSION
0503T NONINVASIVE ESTIMATED CORONARY FRACTIONAL FLOW RESERVE (FFR) DERIVED FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY DATA USING COMPUTATION FLUID DYNAMICS PHYSIOLOGIC SIMULATION SOFTWARE ANALYSIS OF FUNCTIONAL DATA TO ASSESS THE SEVERITY OF CORONARY ARTERY DISEASE; ANALYSIS OF FLUID DYNAMICS AND SIMULATED MAXIMAL CORONARY HYPEREMIA, AND GENERATION OF ESTIMATED FFR MODEL
0504T NONINVASIVE ESTIMATED CORONARY FRACTIONAL FLOW RESERVE (FFR) DERIVED FROM CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY DATA USING COMPUTATION FLUID DYNAMICS PHYSIOLOGIC SIMULATION SOFTWARE ANALYSIS OF FUNCTIONAL DATA TO ASSESS THE SEVERITY OF CORONARY ARTERY DISEASE; ANATOMICAL DATA REVIEW IN COMPARISON WITH ESTIMATED FFR MODEL TO RECONCILE DISCORDANT DATA, INTERPRETATION AND REPORT

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

Use of this code does not guarantee reimbursement. The patient’s medical record must document that the coverage criteria in the related policy have been met.

Group 1 Codes
CodeDescription
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation

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

Group 1

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Group 1 Codes

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ICD-10-PCS Codes

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Additional ICD-10 Information

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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.

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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.

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Other Coding Information

Group 1

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Group 1 Codes

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Associated Documents

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
01/14/2022 N/A - N/A N/A You are here

Keywords

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