LCD Reference Article Response To Comments Article

Response to Comments: MolDX: Chromosome 1p/19q Deletion Analysis

A54780

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Source Article ID
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Article ID
A54780
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: MolDX: Chromosome 1p/19q Deletion Analysis
Article Type
Response to Comments
Original Effective Date
02/01/2016
Revision Effective Date
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Revision Ending Date
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The comment period began on 10/21/15 and ended on 12/07/2015. Comments were received from the provider community. The notice period begins on 12/17/2015 and ends1/31/2016. The LCD becomes final on 2/1/2016.

Response To Comments

Number Comment Response
1 Indications for Testing Requestor requested addition of small cell glioblastomas and neurocytic tumors to indications. Small cell glioblastomas and neurocytic tumor indications have been added to the LCD.
2 Once in a Life Time Testing Requestor indicates that the clinical scenarios may dictate more frequent testing than once-in-a-lifetime, such as for recurrent oligodendrogliomas which may exhibit histologic features of astrocytic gliomas as a result of therapeutic interventions, or when small biopsies of treated sites product features of astrocytic hyperplasia that can be confused with recurrent tumor. A denied claim for repeat testing may be appealed with medical record documentation specifically demonstrating why repeat testing was indicated.
3 CPT/HCPCS Codes Requestor wants the following CPT codes.
  • 81406 – Molecular pathology procedure, Level 7
  • 88373 – Morphometric analysis, in situ hybridization, (quant or semiquant), computer-assisted technology, per specimen, each additional single probe stain procedures
  • 88374 – Morphometric analysis, in situ hybridization, computer-assisted technology, per specimen; each multiplex probe stain procedure
  • 88369 – Morphometric analysis, in situ hybridization (quant or semiquant), manual, per specimen; each additional single probe stain procedure
  • 88377 – Morphometric analysis, in situ hybridization (quant or semi-quant), manual, per specimen; each multiplex probe stain procedure
This Medicare contractor will not add the code header for CPT 81406 because no specific gene under CPT 81406 was requested. CPT 88374 and 88377 will not be added as 1p/19q deletion analysis is not currently available as a multiplex stain.
4 ICD-10 Codes In addition to the specific ICD-10 codes in the LCD, consideration of the following codes was requested: C72.0 Malignant neoplasm of spinal cord C72.9 Malignant neoplasm of central nervous system, unspecified C79.31 Secondary malignant neoplasm of brain C79.32 Secondary malignant neoplasm of cerebral meninges D33.0 Benign neoplasm of brain, supratentorial D33.1 Benign neoplasm of brain, infratentorial D33.2 Benign neoplasm of brain, unspecified D43.0 Neoplasm of uncertain behavior of brain, supratentorial D33.7 Benign neoplasm of other specified parts of central nervous system D33.9 Benign neoplasm of central nervous system, unspecified D43.0 Neoplasm of uncertain behavior of brain, supratentorial D43.1 Neoplasm of uncertain behavior of brain, infratentorial D43.2 Neoplasm of uncertain behavior of brain, unspecified D43.8 Neoplasm of uncertain behavior of other specified parts of central nervous system D43.9 Neoplasm of uncertain behavior of central nervous system, unspecified D49.6 Neoplasm of unspecified behavior of brain G93.89 Other specified disorders of brain G93.9 Disorder of brain, unspecified G94 Other disorders of brain in diseases classified elsewhere H47.611 Cortical blindness, right side of brain H47.612 Cortical blindness, left side of brain H47.619 Cortical blindness, unspecified side of brain H47.631 Disorders of visual cortex in (due to) neoplasm, right side of brain H47.632 Disorders of visual cortex in (due to) neoplasm, left side of brain H47.639 Disorders of visual cortex in (due to) neoplasm, unspecified side of brain Z85.841 Personal history of malignant neoplasm of brain Z86.011 Personal history of benign neoplasm of the brain This Medicare contractor will add C72.0 to the LCD. C72.9 is too non-specific to provide diagnostic coding clarity and specificity. Testing for 1p/19q deletion is indicated to rule in or rule out a presumed malignant glial tumor. Therefore, ICD-10 codes for benign neoplasms, neoplasm of uncertain behavior, secondary neoplasm to the brain or meninges, other specified or unspecified disorders of brain, cortical blindness, disorders of visual cortex, and personal history of benign or malignant neoplasms are non-specific diagnosis and would not justify 1p/19q deletion analysis.
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