LCD for Pulmonary Perfusion Imaging (L1594)

 

Contractor Information

Contractor Name 

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator) 

Contractor Number 

00390 

Contractor Type 

FI 

 

LCD Information

LCD ID Number 

L1594 

 

LCD Title 

Pulmonary Perfusion Imaging 

 

Contractor's Determination Number 

1594 

 

AMA CPT / ADA CDT Copyright Statement 

CPT codes, descriptions and other data only are copyright 2006 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  

 

CMS National Coverage Policy 

Title XVIII of the Social Security Act, Section 1862 (a)(1)(A). This section excludes coverage of items or services that are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, Section 1862 (a)(7). This section prohibits Medicare payment for any expenses on items and services incurred for routine physical examinations.

Title XVIII of the Social Security Act, Section 1833 (e). This section prohibits Medicare payment for any claim that lacks the necessary information to process the claim.

 

 

Primary Geographic Jurisdiction 

New Jersey
Tennessee
 

 

Secondary Geographic Jurisdiction 

Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
North Carolina
North Dakota
Nebraska
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
 

 

Oversight Region 

Region IV
 

 

 

Original Determination Effective Date 

For services performed on or after 12/27/1996  

 

Original Determination Ending Date 

 

 

Revision Effective Date 

For services performed on or after 08/06/2005  

 

Revision Ending Date 

 

 

Indications and Limitations of Coverage and/or Medical Necessity 

Test to assess ventilation perfusion patterns

Clinically indicated for: Determination of arterial perfusion of the lungs, detection of pulmonary emboli, evaluation, preoperatively of the pulmonary function of a patient with marginal lung reserves; for example, when a physician is removing a portion of the lung and he/she needs to verify the perfusion status of the opposite lung to see if the patient could survive the surgery. 

 

Coverage Topic 

Diagnostic Tests and X-Rays
 

 

Coding Information

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 policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

13x

Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)

 

 

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 policy 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 policy should be assumed to apply equally to all Revenue Codes.

 

032X

Radiology diagnostic-general classification

034X

Nuclear medicine-general classification

035X

Computed tomographic (CT) scan-general classification

040X

Other imaging services-general classification

061X

Magnetic resonance technology (MRT)-general classification

 

 

CPT/HCPCS Codes 

 

78580

PULMONARY PERFUSION IMAGING, PARTICULATE

78584

PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; SINGLE BREATH

 

 

ICD-9 Codes that Support Medical Necessity 

 

413.9

OTHER AND UNSPECIFIED ANGINA PECTORIS

415.11 - 415.19

IATROGENIC PULMONARY EMBOLISM AND INFARCTION - OTHER PULMONARY EMBOLISM AND INFARCTION

511.9

UNSPECIFIED PLEURAL EFFUSION

514

PULMONARY CONGESTION AND HYPOSTASIS

518.0

PULMONARY COLLAPSE

786.09

RESPIRATORY ABNORMALITY OTHER

786.3

HEMOPTYSIS

786.50 - 786.59

UNSPECIFIED CHEST PAIN - OTHER CHEST PAIN

 

 

Diagnoses that Support Medical Necessity 

 

 

ICD-9 Codes that DO NOT Support Medical Necessity 

 

017.00

TUBERCULOSIS OF SKIN AND SUBCUTANEOUS CELLULAR TISSUE UNSPECIFIED EXAMINATION

427.31

ATRIAL FIBRILLATION

486

PNEUMONIA ORGANISM UNSPECIFIED

490

BRONCHITIS NOT SPECIFIED AS ACUTE OR CHRONIC

728.85

SPASM OF MUSCLE

780.2

SYNCOPE AND COLLAPSE

780.4

DIZZINESS AND GIDDINESS

780.91

FUSSY INFANT (BABY)

780.92

EXCESSIVE CRYING OF INFANT (BABY)

780.99

OTHER GENERAL SYMPTOMS

784.0

HEADACHE

785.0

TACHYCARDIA UNSPECIFIED

786.2

COUGH

789.00 - 789.09

ABDOMINAL PAIN UNSPECIFIED SITE - ABDOMINAL PAIN OTHER SPECIFIED SITE

V72.6

LABORATORY EXAMINATION

 

 

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 

 

 

Diagnoses that DO NOT Support Medical Necessity 

 

 

General Information

Documentation Requirements 

Medical documentation for all perfusion studies, which are covered by Medicare or submitted for payment to Medicare, is expected to indicate the clear and concise medical necessity within the patient’s medical record, should chart review become necessary. Symptomatology and/or appropriate diagnosis must justify the testing performance. If documentation is requested, submit:

 

  • History and physical
  • MD orders/progress notes
  • Test results
  • Itemization of charges

 

 

Appendices 

LINK TO QUESTIONS AND ANSWERS (COMMENTS) ABOUT THIS
POLICY:

Frequently Asked Questions


 

 

Utilization Guidelines 

 

 

Sources of Information and Basis for Decision 

Carrier Policy 

 

Advisory Committee Meeting Notes 

This policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from appropriate specialties as well as provider (facility) representatives. 

 

Start Date of Comment Period 

 

 

End Date of Comment Period 

 

 

Start Date of Notice Period 

11/27/1996 

 

Revision History Number 

1594a 

 

Revision History Explanation 

07/24/2002 Formatted

01/10/2001 checked CPT codes by 2001 Code Book

11/07/2000 checked ICD-9 codes with ICD-9 Code Book

This LCD was converted from an LMRP on 8/5/2005

7/2/2006 - The description for Bill code 14 was changed

09/03/2007 - This policy was updated by the ICD-9 2007-2008 Annual Update.

09/27/2007 - Frequently Asked Questions restored to Appendices 

 

Reason for Change 

ICD9 Addition/Deletion
 

Last Reviewed On Date 

09/27/2007 

 

Related Documents 

Article(s)
A35314 - Pulmonary Perfusion Imaging

 

LCD Attachments 

FAQ - Comment and Response (900 bytes)

 

Other Versions 

Updated on 09/01/2006 with effective dates 08/06/2005 - N/A

Updated on 07/02/2006 with effective dates 08/06/2005 - N/A

Updated on 08/05/2005 with effective dates 08/06/2005 - N/A

Updated on 08/05/2005 with effective dates 07/24/2002 - 08/05/2005

Updated on 09/22/2003 with effective dates 07/24/2002 - N/A

Updated on 03/11/2003 with effective dates 07/24/2002 - N/A

Updated on 10/04/2002 with effective dates 07/24/2002 - N/A