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

R4 (effective 12/16/2010): Due to a typographical error, ICD-9-CM code 428.22 was included in the “ICD-9-CM Codes that Support Medical Necessity” section. The correct ICD-9-CM code is 428.23. Coverage forICD-9-CM code 428.23 is retroactive to the original effective date of April 1, 2008. Minor changes weremade to reflect current template language. No comment and notice periods required and none given.LCD for Outpatient Physical and Occupational Therapy Services – L26884R7 (published 12/22/2010, effective retroactive to 11/1/2011): The requirement for the use of the V57.1-V57.89 codes to identify the therapy plan under which service are provided has been deleted, per CMSclarification that such coding is not required in the LCD. Bill type 11X deleted. No comment or noticeperiod required and none given.Article for Outpatient Physical and Occupational Therapy Services – Supplemental InstructionsArticle (A49932)Article published December 2010: The LCD and SIA were revised to delete coding instructions thatrequired ICD-9-CM codes V57.1-V57.89 to be included as the primary diagnosis on all therapy claims(retroactive to 11/01/2010). Furthermore, National Government Services will not require these diagnosiscodes whether as primary or subsequent codes. National Government Services does, however, note thatsuch a recommendation does exist in the ICD-9-CM manual. If providers use these codes, they must alsoinclude the diagnosis code of the specific medical condition for which each therapy service was provided.Bill type 11X removed.January Revisions:LCD for Allergy Immunotherapy (L28451)R3 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed, and no changes required other than for minor formatting for NationalGovernment Services and CMS template language. No comment and notice periods required and nonegiven.Article for Allergy Immunotherapy - Supplemental Instructions Article (A47997)Article published January 2011: Annual review per CMS Program Integrity Manual, Chapter 13, Section13.4[C]. Content reviewed and no changes required other than minor formatting for NationalGovernment Services and CMS template language.Article for Apligraf® – Related to LCD L26003 (A46092)Article published January 2011: Due to the annual HCPCS update for 2011, HCPCS codes G0440 andG0441 were added to the following coding guideline:Payable places of service for the application of Apligraf® (CPT codes 15340 and 15341 for dates of serviceprior to January 1, 2011 and HCPCS codes G0440 and G0441 for dates of service on or after January 1,2011): office (11), urgent care facility (20), inpatient hospital (21), outpatient hospital (22), hospitalemergency room (23), ambulatory surgical center (24), skilled nursing facility (31), nursing facility (32)and independent clinic (49).HCPCS codes G0440 and G0441 were added to the “CPT/HCPCS Codes” section of the SIA. Thefollowing explanatory notes regarding the usage of HCPCS codes G0440 and G0441 and CPT codes 15340and 15341 were added to this section:Effective for dates of service on or after 01/01/2011, HCPCS codes G0440 and G0441 should be reportedfor the application of Apligraf® to the lower extremity.CPT codes and descriptors are only copyright 2010 American Medical Association (or such other date publication of CPT)The Medicare Monthly Review 7 MMR 2011-01, January 2011