Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for November 22, 2011

Medical Guidelines Reason for Update
Bronchial Thermoplasty Deleted HCPCS codes C9730 and C9731 from the Billing/Coding section for 2012.
Chemoembolization of the Hepatic Artery, Transcatheter Approach Corrected coding format for diagnoses in the "Billing/Coding" section.
Cord Blood as a Source of Stem Cells Added the following diagnoses to the "Billing/Coding" section; 650, 654.21, 656.61, V59.02, and V59.09.
Endothelial Keratoplasty Added CPT codes 0289T, 0290T and HCPCS code C9732 to Billing/Coding section effective 1/1/2012.
Genetic Testing for Cutaneous Malignant Melanoma New policy implemented. Genetic testing for mutations associated with hereditary cutaneous malignant melanoma or associated with susceptibility to cutaneous malignant melanoma is considered investigational. Medical Director review 8/2011. Notice given 8/16/11 for effective date 11/22/11.
Genetic Testing for Non-Malignant Inherited Disorders New policy implemented. Genetic testing for non-malignant inherited disorders may be considered medically necessary when the following criteria are met: The genetic disorder is associated with significant disability or has a lethal natural history; AND The risk of the significant disability or lethality from the genetic disorder cannot be determined through other diagnostic testing, AND A specific mutation, or set of mutations, has been proven valid in the scientific literature to be reliably associated with the disease; AND The results of the genetic test could impact the medical management of the individual being tested; AND The genetic test will likely result in an anticipated improvement in net health outcomes for the individual being tested; (i.e. the disease is treatable or preventable) AND Testing is accompanied by genetic counseling AND Proper informed consent is obtained. Genetic testing for individuals not meeting the above criteria is considered not medically necessary. Whole genome sequencing in which an individual's entire DNA is sequenced is considered investigational. Use of home testing kits is considered investigational. Notice given 8/16/11 for effective date 11/22/11.
Radioembolization for Primary and Metastatic Tumors of the Liver Removed the x from the ICD-9 codes 153.0, 153.1, 155.0, 155.1, 155.2, 197.7, 573.8, 573.9 in the Billing/Coding section since there are no 5th digits for these codes.
Rituximab for the Treatment of Rheumatoid Arthritis Removed the x from the ICD-9 codes 714.0, 714.4, 714.8, 720.0 in the Billing/Coding section since there are no 5th digits for these codes.
Temporomandibular Joint Dysfunction (TMJD) Extensive revisions, renumbering and bulleting under "When Not Covered and Covered Sections." Under "When Not Covered" section added: ultrasound imaging and sonogram. Removed statement "Braces and orthodontic treatment of TMJD are considered dental therapy and are not eligible under medical benefits" from Policy section. Specialty Matched Consultant Advisory Panel 10/26/2011.
Evidence Based Guidelines
Pachymetry Medical Director review 9/9/2011. Evidence based guideline archived.
Glaucoma, Evaluation by Ophthalmologic Techniques Deleted CPT codes 92120, 93875 from Billing/Coding section.
Intraoperative Radiation Therapy Added CPT codes 77424, 77425, 77469 to Billing/Coding section effective 1/1/2012.