The Medicare Monthly Review, MMR-2011-01, January 2011 - CGS

For dates of service prior to 01/01/2011, CPT codes 15365 and 15366 should be reported for the applicationof Dermagraft®.Article for Denosumab (Prolia , Xgeva ) - Related to LCD L25820 (A50361)Article published 01/01/2011: The “Indications” section of the article has been revised to include FDAapproved indication for denosumab Xgeva for the treatment of bone metastases from solid tumorseffective 11/18/2010. The following indication has also been added to the “Indications” section of thearticle:• For patients with significant renal failure where treatment with biphosphonate is not indicated,CrCl less than 35 ml/min.The “Limitations” section of the article has been revised to include that denosumab (Xgeva) is notapproved for patients with multiple myeloma or other cancer of the blood. The “Documentation” sectionof the article has been revised to include that the patients medical record should include documentationof bone metastasis from a solid tumor and adequate calcium levels as well as the use of Vitamin D ifindicated for denosumab (Xgeva). The “Utilization” section of the article has been revised to includethat denosumab (Xgeva) is administered at a dose of 120mg every four weeks as a subcutaneousinjection. In the “ICD-9 Codes that Are Covered” section ICD-9-CM code 198.5 has been added as aprimary diagnoses and ICD-9 codes 585.3, 585.4 and 585.5 have been added to the secondary diagnosislist effective for dates of service on or after 01/01/2011. In the “General Guidelines” section Xgeva hasbeen added to Coding Guidelines 1 and 2. The article has been revised to indicate that effective for datesof service on or after 01/01/2011, HCPCS code C9272 should be used to report denosumab (Prolia,Xgeva) for claims submitted to the FI or Part A MAC.LCD for Dialysis Access Maintenance (L30737)R2 (effective date 01/01/2011): LCD revised for annual CPT code updates. CPT codes 35473, 35474, and75964 were deleted from the policy. Descriptors were changed for CPT codes 36832, 37205, 37206, 75710,75791, 75820, 75822, 75825, 75827, 75896, and 75960. Minor formatting changes were made to update forNational Government Services template changes. No notice given and none required.Article for Dialysis Access Maintenance – Supplemental Instructions Article (A49635)Article published January 2011: Updated for annual CPT code updates. CPT codes 35473, 35474, 75962,and 75964 were deleted from the policy. Descriptors were changed for CPT codes 36832, 37205, 37206,75710, 75791, 75820, 75822, 75825, 75827, 75896, and 75960. Minor formatting changes were made toupdate for NATIONAL GOVERNMENT SERVICES template changes.LCD for Dynamic Electrocardiography (EKG, ECG) – L26409R4 (effective 01/01/2011): LCD revised for annual HCPCS updates for 2011: descriptors for CPT codes93224, 93225, 93226, and 93227 revised and CPT codes 93230, 93231, 93232, 93233, 93235, 93236, and 93237deleted. References to 24-hour recording replaced by reference to up to 48 hours, to reflect revised CPTcodes. Information added to Limitations and Documentation Requirements for recordings of less than 12hours. No comment and notice periods required and none given.Article for Dynamic Electrocardiography (EKG, ECG) – Supplemental Instructions Article (A45925)Article published January 2011: SIA revised for annual HCPCS updates for 2011: descriptors for CPTcodes 93224, 93225, 93226, and 93227 revised and CPT codes 93230, 93231, 93232, 93233, 93235, 93236, and93237 deleted, effective January 1, 2011. Modifier instruction added for reporting scans of less than 12hours.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 13 MMR 2011-01, January 2011