RE: Medicare ICD-9 Code

[Guest guest]

Medicare’s coverage manual section #110.8.1 lists the following uses of allogeneic HSCT as covered under Medicare: i. Effective for services performed on or after August 1, 1978, for the treatment of leukemia, leukemia in remission, or aplastic anemia when it is reasonable and necessary, ii. Effective for services performed on or after June 3, 1985, for the treatment of severe combined immunodeficiency disease (SCID) and for the treatment of Wiskott-Aldrich syndrome. iii. Effective for services performed on or after August 4, 2010, for the treatment of Myelodysplastic Syndromes (MDS) pursuant to Coverage with Evidence Development (CED) in the context of a Medicare-approved, prospective clinical study. The manual itself doesn’t use CPT codes to define these covered diagnoses. The MDS CED requires enrollment in the recent CIBMTR Medicare MDS study, and that study does have defined subtypes that are included: http://www.cibmtr.org/Studies/ClinicalTrials/HCT-MDS/Documents/CMS-MDS%20FAQ%27s.pdf. If the patient meets one of those criteria then you should use the associated ICD-9 code and the transplant can be covered if you participate in that CIBMTR study. Regarding 284.1, that’s definitely not a billable code and needs an additional digit. When you said that 284.1 is an approved code, who approved it? Do you mean that it passed your internal billing system code edits? If so, that may be someone else’s idea of what Medicare should cover and may not reflect actual coverage. GoldsteinBusiness Manager, Stanford BMT Program300 Pasteur Drive, H0101Stanford, CA 94305~ - direct~650.725-3117 - fax~ - BMT office ***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.*** From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dhami, RajwantSent: Wednesday, August 01, 2012 3:11 PMTo: 'TxFinancialCoordinators 'Subject: Medicare ICD-9 Code I have a pt that has Medicare and her diagnosis is Polycythemia Vera 238.4. This pt is referred to us for possible Allogeneic Stem Cell Transplant. Dx code 238.4 is not an approved code on our Medicare list for Allogeneic Stem Cell Transplant. My physician is trying to update the code to 284.1 ( Pancytopenia into our electronic chart system ) 284.1 is a approved code. However the problem is our electronic chart system doesn’t take 4 digit ICD-9 codes. Does anyone know where I can confirm if ICD-9 code 284.19 (Pancytopenia, acquired) is an approved code by Medicare for pt's receiving Allogeneic Stem Cell Transplant or if this code is the same as 284.1 ? The system is also giving him to pick from 284.11, 284.12 not sure if any of these are also Medicare approved codes and if they are considered to be the same as 284.1 I contacted Medicare and the lady guided me to look online but I was not able to find anything on the Medicare website. Please advise.. Rajwant DhamiBMT Financial CoordinatorBlood and Marrow Transplant Program2800 L Street, Suite 440Sacramento, CA 95816office fax(916)454-6929

[Guest guest]

ICD-9 CODE 284.1 is not from our internal system. This code is on the Medicare approved list which I received form the Medicare website.

This pt 's diagnosis falls under Aplastic Anemia (ICD-9-CM codes 284.0 through 284.9), Therefore 284.1 was the code my physician was selecting. If ICD-9 code 284.1 Pancytopenia is not a billable code then does anyone have a list of billable codes that fall under the diagnosis of Pancytopenia and are approved by Medicare ?

Below is the list of approved codes by Medicare for Allogeneic Stem Cell Transplant I printed from Medicare's website publication# 35-30.1.

Allogeneic Stem Cell Transplantation. Allogeneic stem cell transplantation (ICD-9-CM procedure codes 41.02, 41.03, 41.05, and 41.08) is a procedure in which a portion of a healthy donor's stem cell or bone marrow is obtained and prepared for intravenous infusion.

Covered Conditions. The following uses of Allogeneic bone marrow transplantation are covered under Medicare:

Effective for services performed on or after August 1, 1978, for the treatment of leukemia, leukemia in remission (ICD-9-CM codes 204.00 through 208.91), or aplastic anemia (ICD-9-CM codes 284.0 through 284.9) when it is reasonable and necessary; and

Effective for services performed on or after June 3, 1985, for the treatment of severe combined immunodeficiency disease (SCID) (ICD-9-CM code 279.2), and for the treatment of Wiskott - Aldrich syndrome (ICD-9-CM 279.12).

Noncovered Conditions. Effective May 24, 1996, allogeneic stem cell transplantation is not covered as treatment for multiple myeloma (ICD-9-CM codes 203.0 and 238.6).

Rajwant Dhami BMT Financial Coordinator Blood and Marrow Transplant Program 2800 L Street, Suite 440 Sacramento, CA 95816 office fax(916)454-6929

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Goldstein, Sent: Wednesday, August 01, 2012 3:54 PMTo: TxFinancialCoordinators Subject: RE: Medicare ICD-9 Code

Medicare’s coverage manual section #110.8.1 lists the following uses of allogeneic HSCT as covered under Medicare:

i. Effective for services performed on or after August 1, 1978, for the treatment of leukemia, leukemia in remission, or aplastic anemia when it is reasonable and necessary,

ii. Effective for services performed on or after June 3, 1985, for the treatment of severe combined immunodeficiency disease (SCID) and for the treatment of Wiskott-Aldrich syndrome.

iii. Effective for services performed on or after August 4, 2010, for the treatment of Myelodysplastic Syndromes (MDS) pursuant to Coverage with Evidence Development (CED) in the context of a Medicare-approved, prospective clinical study.

The manual itself doesn’t use CPT codes to define these covered diagnoses. The MDS CED requires enrollment in the recent CIBMTR Medicare MDS study, and that study does have defined subtypes that are included: http://www.cibmtr.org/Studies/ClinicalTrials/HCT-MDS/Documents/CMS-MDS%20FAQ%27s.pdf. If the patient meets one of those criteria then you should use the associated ICD-9 code and the transplant can be covered if you participate in that CIBMTR study.

Regarding 284.1, that’s definitely not a billable code and needs an additional digit. When you said that 284.1 is an approved code, who approved it? Do you mean that it passed your internal billing system code edits? If so, that may be someone else’s idea of what Medicare should cover and may not reflect actual coverage.

Goldstein

Business Manager, Stanford BMT Program

300 Pasteur Drive, H0101

Stanford, CA 94305

~ - direct

~650.725-3117 - fax

~ - BMT office

***This email and any attachments may contain confidential information for the use of the designated recipient(s) named above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its content is prohibited. If you have received this email in error, please immediately notify Stanford University Medical Center at . ~Thank You.***

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of Dhami, RajwantSent: Wednesday, August 01, 2012 3:11 PMTo: 'TxFinancialCoordinators 'Subject: Medicare ICD-9 Code

I have a pt that has Medicare and her diagnosis is Polycythemia Vera 238.4. This pt is referred to us for possible Allogeneic Stem Cell Transplant. Dx code 238.4 is not an approved code on our Medicare list for Allogeneic Stem Cell Transplant.

My physician is trying to update the code to 284.1 ( Pancytopenia into our electronic chart system ) 284.1 is a approved code. However the problem is our electronic chart system doesn’t take 4 digit ICD-9 codes.

Does anyone know where I can confirm if ICD-9 code 284.19 (Pancytopenia, acquired) is an approved code by Medicare for pt's receiving Allogeneic Stem Cell Transplant or if this code is the same as 284.1 ?

The system is also giving him to pick from 284.11, 284.12 not sure if any of these are also Medicare approved codes and if they are considered to be the same as 284.1

I contacted Medicare and the lady guided me to look online but I was not able to find anything on the Medicare website.

Please advise..

Rajwant Dhami

BMT Financial Coordinator

Blood and Marrow Transplant Program

2800 L Street, Suite 440

Sacramento, CA 95816

office fax(916)454-6929