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Department of Health & Program Memorandum Human Services (DHHS) Centers for Medicare & Intermediaries/Carriers Medicaid Services (CMS) Transmittal AB-02-085 Date: JUNE 20, 2002 CHANGE REQUEST 2194 SUBJECT: Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) I. GENERAL INFORMATION A. Background: In 1979, use of ICD-9-CM codes became mandatory for reporting provider services on Form CMS-1450. On April 1, 1989, use of ICD-9-CM codes became mandatory for all physician services submitted on Form CMS-1500. ICD-9-CM codes are updated annually. The CMS sends the ICD-9 Addendum out to the regional offices and Medicare contractors annually. B. Policy: This instruction serves as a reminder to Medicare contractors regarding the annual ICD-9- CM coding update for claims processed on or after October 1, 2002. The Addendum containing the new and revised codes is being sent to you as Word documents attached to this instruction. II. BUSINESS REQUIREMENTS • use the word “must” to indicate a mandatory action • use the word “will” to indicate an optional action • Resp. column is optional Req. # Requirements Resp. 1.1 Medicare systems are required to install and accept new and FI & revised 2002 ICD-9-CM update for claims processed on or Carrier after October 1, 2002. 1.2 For those carriers that process claims on the Multi-Carrier Carrier System (MCS) effective for claims processed on or after October 1, 2002, MCS must be able to edit for the validity of diagnosis codes based on the date of service of the procedure code to which the diagnosis is correlated. Refer to Transmittal B-02-027, dated April 26, 2002 for more information. 1.3 Medicare systems must accept both the old and new ICD-9- CM codes for dates of service October 1, 2002 through Carrier December 31, 2002. 1.4 VMS will process by date of service in the future. Until Carrier then process the new ICD-9 update as in the past effective October 1, 2002. 1.5 Effective October 1, 2002, HPBSS should install and process Carrier claims using the new ICD-9 update as in the past. CMS-Pub. 60AB 2 III. SUPPORTING INFORMATION AND POSSIBLE DESIGN CONSIDERATIONS A. Other Instructions: X-Ref Req. # Instructions 1.1 Medicare carriers must post a notice on their Website that reminds providers that they can begin to use the revised/new ICD-9-CM codes for claims submitted on or after October 1, 2002. Include the following new CMS Web site address that contains the new, revised and deleted ICD-9-CM codes. CMS has posted these codes on the Web as a courtesy for providers. The address is http://www.cms.hhs.gov/medlearn/icd9code.asp 1.1 In the same Web notice Medicare carriers should include information explaining the options available to providers for obtaining the updated ICD-9-CM codes. 1.1 Also in the same notice, Medicare carriers should emphasize the importance for providers to use the most recent version of the ICD-9- CM coding book and to code to the highest level of specificity. 1.2 Carriers using MCS system should educate providers that the diagnosis on the claim should be the diagnosis that was valid at the time the procedure was performed. 1.1 Medicare intermediaries must use their Web site to remind providers that they can begin to use the revised/new ICD-9-CM codes for claims submitted on or after October 1, 2002. 1.1 In the Web notice, Medicare intermediaries must encourage/remind hospitals to send a copy to the director of medical records. 1.1 Medicare intermediaries must handle questions on the operation of GROUPER, MCE and OCE in accordance with regular procedures. 1.1 For diagnosis coding questions, Medicare intermediaries must contact Donna Pickett or Amy Blum at 301-458-4200 at the National Center for Health Statistics. 1.1 For procedure coding questions, Medicare intermediaries must contact Pat Brooks at 410-786-5318, Ann Fagan at 410-786-5662 or Amy Gruber at 410-786-1542, CMS Division of Acute Care. B. Design Considerations: X-Ref Req. # Recommendation for Medicare System Requirements C. Interfaces: Grouper v20.0, Medicare Code Editor v19.0, and Outpatient Code Editor v3.2 D. Contractor Financial Reporting /Workload Impact: E. Dependencies: The Addendum is being sent as an attachment to this instruction. IV. Attachment(s) 3 Volumes Version: Effective Date: October 1, 2002 Implementation Date: October 1, Funding: Within Current Operating Budget 2002 Pre-Implementation Contact: Pat Gill for Discard Date: October 1, 2003 Part B (6-1297) and Barbara Strickland for Part A (6-0508) Post-Implementation Contact: Appropriate Regional Office FY 2003 Final Addenda ICD-9-CM Volume 3, Procedures Effective October 1, 2002 Tabular List New chapter 00 Procedures and interventions, Not Elsewhere Classified New subcategory 00.0 Therapeutic ultrasound New code 00.01 Therapeutic ultrasound of vessels of head and neck Anti-restenotic ultrasound Intravascular non-ablative ultrasound Excludes: diagnostic ultrasound of: eye (95.13) head and neck (88.71) that of inner ear (20.79) ultrasonic: angioplasty of non-coronary vessel (39.50) embolectomy (38.01, 38.02) endarterectomy (38.11, 38.12) thrombectomy (38.01, 38.02) New code 00.02 Therapeutic ultrasound of heart Anti-restenotic ultrasound Intravascular non-ablative ultrasound Excludes: diagnostic ultrasound of heart (88.72) ultrasonic ablation of heart lesion (37.34) ultrasonic angioplasty of coronary vessels (36.01, 36.02, 36.05, 36.09) New code 00.03 Therapeutic ultrasound of peripheral vascular vessels Anti-restenotic ultrasound Intravascular non-ablative ultrasound Excludes: diagnostic ultrasound of peripheral vascular system (88.77) ultrasonic angioplasty of: non-coronary vessel (39.50) New code 00.09 Other therapeutic ultrasound Excludes: ultrasonic: fragmentation of urinary stones (59.95) percutaneous nephrostomy with fragmentation (55.04) physical therapy (93.35) transurethral guided laser induced prostatectomy (TULIP) (60.21) New subcategory 00.1 Pharmaceuticals New code 00.10 Implantation of chemotherapeutic agent Brain wafer chemotherapy Interstitial/ intracavitary Excludes: injection or infusion of cancer chemotherapeutic substance (99.25) New code 00.11 Infusion of drotrecogin alfa (activated) Infusion of recombinant protein New code 00.12 Administration of inhaled nitric oxide Nitric oxide therapy New code 00.13 Injection or infusion of nesiritide Human B-type natriuretic peptide (hBNP) New code 00.14 Injection or infusion of oxazolidinone class of antibiotics Linezolid injection New subcategory 00.5 Other cardiovascular procedures New code 00.50 Implantation of cardiac resynchronization pacemaker without mention of defibrillation, total system [CRT-P] Biventricular pacing without internal cardiac defibrillator Implantation of cardiac resynchronization (biventricular) pulse generator pacing device, formation of pocket, transvenous leads including placement of lead into left ventricular coronary venous system, and intraoperative procedures for evaluation of lead signals. 2 Excludes: implantation of cardiac resynchronization defibrillator, total system [CRT-D] (00.51) insertion or replacement of any type pacemaker device (37.80-37.87) replacement of cardiac resynchronization defibrillator pulse generator only [CRT-D](00.54) replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P](00.53) New code 00.51 Implantation of cardiac resynchronization defibrillator, total system [CRT-D] Biventricular pacing with internal cardiac defibrillator Implantation of a cardiac resynchronization (biventricular) pulse generator with defibrillator [AICD], formation of pocket, transvenous leads, including placement of lead into left ventricular coronary venous system, intraoperative procedures for evaluation of lead signals, and obtaining defibrillator threshold measurements. Excludes: implantation of cardiac resynchronization pacemaker, total system [CRT-P](00.50) implantation or replacement of automatic cardioverter/defibrillator, total system [AICD] (37.94) replacement of cardiac resynchronization defibrillator pulse generator, only [CRT-D](00.54) New code 00.52 Implantation or replacement of transvenous lead [electrode] into left ventricular coronary venous system Excludes: implantation of cardiac resynchronization defibrillator, total system [CRT-D](00.51) implantation of cardiac resynchronization pacemaker, total system [CRT-P](00.50) 3 initial insertion of transvenous lead [electrode] (37.70-37.72) replacement of transvenous atrial and/or ventricular lead(s) [electrodes] (37.76) New code 00.53 Implantation or replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P] Implantation of CRT-P device with removal of any existing CRT-P or other pacemaker device Excludes: implantation of cardiac resynchronization pacemaker, total system [CRT-P] (00.50) implantation or replacement of cardiac resynchronization defibrillator pulse generator only [CRT-D](00.54) insertion or replacement of any type pacemaker device (37.80-37.87) New code 00.54 Implantation or replacement of cardiac resynchronization defibrillator pulse generator device only [CRT-D] Implantation of CRT-D device with removal of any existing CRT-D, CRT-P, pacemaker, or defibrillator device Excludes: implantation of automatic cardioverter/defibrillator pulse generator only (37.96) implantation of cardiac resynchronization defibrillator, total system [CRT-D] (00.51) implantation or replacement of cardiac resynchronization pacemaker pulse generator only [CRT-P] (00.53) New code 00.55
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