HealthNow UMD
Article -- Coding Guidelines

Contractor Name
HealthNow

Contractor Number
00801

Contractor Type
Carrier

Article Database ID Number
A19357

Article Type
Detailed Article

Article Version Number
4

Article Title
Baclofen Intrathecal Therapy

Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes

CPT codes, descriptions, and other data only are copyright 2006 American Medical Association (or such other data 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. (C) 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

Primary Geographic Jurisdiction
Upstate New York

Article Publication Date
12/31/2003

Article Beginning Effective Date
12/31/2003

Article Revision Effective Date
01/01/2007

Article Ending Effective Date

Coding Guidelines

   1.  The guidelines of the Correct Coding Initiative (CCI) supersede all
       coding instructions in this LCD. For a complete listing of CCI coding
       combinations, refer to CMS' website,
       http://www.cms.hhs.gov/NationalCorrectCodInitEd

   2.  The diagnosis code(s) must best describe the patient's condition for
       which the service was performed.

   3.  Billed services for which the provider expects a medical necessity
       denial should have either the GA (with signed ABN) or GZ (without
       signed ABN) modifier attached to the code. If the service is
       statutorily non-covered or without benefit category, use the GY
       modifier instead.

   4.  The following CPT codes are payable for the places of service as
       indicated:

***Effective for dates of service on or after 01/01/2007, CPT code 76005 is no longer valid.

****Effective for dates of service on or after 01/01/2007, CPT code 77003 replaces CPT code 76005.

   5.  Claims must be submitted with a diagnosis code carried to the highest
       level of specificity, as listed in a current ICD-9-CM code book.

   6.  The creation of the subcutaneous pump pocket is included in CPT code
       62362 and may not be billed separately.

Other Comments

   -   For services that exceed the accepted standard of medical practice and
       may be deemed not medically necessary, the provider/supplier should
       provide the patient with an acceptable advance notice of Medicare's
       possible denial of payment. An advance beneficiary notice (ABN) should
       be signed when a provider/supplier does not want to accept financial
       responsibility for the service.

   -   This Article was converted from an LMRP on 04/15/2004

Related Documents
LCD(s)
L13493 - Baclofen Intrathecal Therapy

Revision History Explanation

Version #4: Revised to reflect changes in HCPCS codes due to 2007 update.

Version #3: Added CPT codes 62311 and 62319 as payable for places of service: inpatient hospital (21), outpatient hospital (22), and ambulatory surgical center (24). Deleted CPT code 96530.