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76377 with ICD I67.1

Leorah Posted Tue 31st of January, 2017 14:59:20 PM
My patient had a Basilar Tip Aneurysm (ICD code I67.1) and to visualize vessel details during embolization provider performed a 3D rendering (76377). NJ Medicare, unlike NY Medicare refused to pay the 76377 because they said this I67.1 does not justify the 76377 per LCDL35408. The patient also had an intractable headache, R51. Would adding ICD R51 justify payment for 76377? In addition, why is NJ Medicare justified in refusing to pay 76377 billed in conjunction with catheterization codes 36221-36228 while they would bill pay the same code when billed with diagnosis I60.7 and embolization codes?
SuperCoder Answered Wed 01st of February, 2017 08:00:35 AM

LCD Policy ID L35408 is for 3D Interpretation and Reporting of Imaging Studies. The limitation of the policy- CPT codes 76376 and 76377 may be considered medically unnecessary and denied if equivalent information obtained from the test has already been provided by another procedure (magnetic resonance imaging, ultrasound, angiography, etc.) or could be provided by a standard Computerized Tomography (CT) scan (two-dimensional) without reconstruction.

CPT code 76376 can be reported when 3D rendering is performed by a radiologist or a specially-trained technologist at the acquisition scanner. However, CPT code 76377 is reported when the 3D post-processing images are reconstructed on an independent workstation with concurrent physician supervision. In order to report CPT code 76377, the supervising physician must provide concurrent supervision.

As per LCD L35408 Support Medical Necessity ICDs are as follows:

R90.82, R91.8, R93.0, R93.1, R93.3, R93.41, R93.421, R93.422, R93.49, R93.5, R93.6, R93.7, R93.8.

And Covered primary diagnosis for deep brain stem lead placement only are as follows:

(The above secondary diagnosis are not required).

G20, G21.4, G24.1, G24.3, G24.9, G25.0, G25.1, G25.2.

If your payment is applicable on the basis of LCD policy ID L35408, then any other ICD will not support the payment of 76377.

Below mentioned are the states where this policy is applicable:

Colorado, New Mexico, Oklahoma, Texas, Arkansas, Louisiana, Mississippi, Delaware, District of Columbia, Maryland, New Jersey, Pennsylvania.

So, other states may allow to pay this code.

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