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.
N/A
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
033X Radiology - Therapeutic and/or Chemotherapy Administration - General Classification
034X Nuclear Medicine - General Classification
035X CT Scan - General Classification
040X Other Imaging Services - General Classification
061X Magnetic Resonance Technology (MRT) - General Classification
CPT/HCPCS Codes
Group 1 Paragraph:
This policy does not take precedence over the Correct Coding Initiative (CCI). Consult current correct coding guidelines for applicable specific code combinations or reductions in payment due to specific codes billed.
The following short descriptors are in accordance with the AMA copyright. Please refer to the current CPT book for full descriptions.
Group 1 Codes:
36200 Place catheter in aorta
36245 Ins cath abd/l-ext art 1st
36246 Ins cath abd/l-ext art 2nd
36247 Ins cath abd/l-ext art 3rd
36248 Ins cath abd/l-ext art addl
36251 Ins cath ren art 1st unilat
36252 Ins cath ren art 1st bilat
36253 Ins cath ren art 2nd+ unilat
36254 Ins cath ren art 2nd+ bilat
75625 Contrast exam abdominl aorta
75630 X-ray aorta leg arteries
75726 Artery x-rays abdomen
G0278 Iliac art angio,cardiac cath
ICD-9 Codes that Support Medical Necessity
Group 1 Paragraph: N/A
Group 1 Codes:
152.0 - 152.9
MALIGNANT NEOPLASM OF DUODENUM - MALIGNANT NEOPLASM OF SMALL INTESTINE UNSPECIFIED SITE
155.0 - 155.2
MALIGNANT NEOPLASM OF LIVER PRIMARY - MALIGNANT NEOPLASM OF LIVER NOT SPECIFIED AS PRIMARY OR SECONDARY
156.0 MALIGNANT NEOPLASM OF GALLBLADDER
156.1 MALIGNANT NEOPLASM OF EXTRAHEPATIC BILE DUCTS
156.8 MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES OF GALLBLADDER AND EXTRAHEPATIC BILE DUCTS
159.0 - 159.9
MALIGNANT NEOPLASM OF INTESTINAL TRACT PART UNSPECIFIED - MALIGNANT NEOPLASM OF ILL-DEFINED SITES WITHIN THE DIGESTIVE ORGANS AND PERITONEUM
189.0 MALIGNANT NEOPLASM OF KIDNEY EXCEPT PELVIS
189.1 MALIGNANT NEOPLASM OF RENAL PELVIS
197.7 MALIGNANT NEOPLASM OF LIVER SECONDARY
198.0 SECONDARY MALIGNANT NEOPLASM OF KIDNEY
209.72 SECONDARY NEUROENDOCRINE TUMOR OF LIVER
223.0 BENIGN NEOPLASM OF KIDNEY EXCEPT PELVIS
223.1 BENIGN NEOPLASM OF RENAL PELVIS
233.9 CARCINOMA IN SITU OF OTHER AND UNSPECIFIED URINARY ORGANS
239.0 NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM
401.0 MALIGNANT ESSENTIAL HYPERTENSION
403.00 HYPERTENSIVE CHRONIC KIDNEY DISEASE, MALIGNANT, WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
403.01 HYPERTENSIVE CHRONIC KIDNEY DISEASE, MALIGNANT, WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.01 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED
404.02 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
404.03 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE
405.01 MALIGNANT RENOVASCULAR HYPERTENSION
405.11 BENIGN RENOVASCULAR HYPERTENSION
405.91 UNSPECIFIED RENOVASCULAR HYPERTENSION
440.0 ATHEROSCLEROSIS OF AORTA
440.1 ATHEROSCLEROSIS OF RENAL ARTERY
440.20 - 440.32*
ATHEROSCLEROSIS OF NATIVE ARTERIES OF THE EXTREMITIES UNSPECIFIED - ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT OF THE EXTREMITIES
441.00 - 441.9
DISSECTION OF AORTA ANEURYSM UNSPECIFIED SITE - AORTIC ANEURYSM OF UNSPECIFIED SITE WITHOUT RUPTURE
442.1 ANEURYSM OF RENAL ARTERY
442.2 ANEURYSM OF ILIAC ARTERY
442.83 ANEURYSM OF SPLENIC ARTERY
442.84 ANEURYSM OF OTHER VISCERAL ARTERY
443.22 DISSECTION OF ILIAC ARTERY
443.23 DISSECTION OF RENAL ARTERY
443.9* PERIPHERAL VASCULAR DISEASE UNSPECIFIED
444.01 SADDLE EMBOLUS OF ABDOMINAL AORTA
444.09 OTHER ARTERIAL EMBOLISM AND THROMBOSIS OF ABDOMINAL AORTA
444.22* ARTERIAL EMBOLISM AND THROMBOSIS OF LOWER EXTREMITY
444.81 EMBOLISM AND THROMBOSIS OF ILIAC ARTERY
445.02 ATHEROEMBOLISM OF LOWER EXTREMITY
445.81 ATHEROEMBOLISM OF KIDNEY
447.3 HYPERPLASIA OF RENAL ARTERY
447.6 ARTERITIS UNSPECIFIED
518.4 ACUTE EDEMA OF LUNG UNSPECIFIED
557.0 ACUTE VASCULAR INSUFFICIENCY OF INTESTINE
557.1 CHRONIC VASCULAR INSUFFICIENCY OF INTESTINE
557.9 UNSPECIFIED VASCULAR INSUFFICIENCY OF INTESTINE
572.3 PORTAL HYPERTENSION
578.0 HEMATEMESIS
578.1 BLOOD IN STOOL
578.9 HEMORRHAGE OF GASTROINTESTINAL TRACT UNSPECIFIED
593.81 VASCULAR DISORDERS OF KIDNEY
593.9 UNSPECIFIED DISORDER OF KIDNEY AND URETER
599.70 - 599.72
HEMATURIA, UNSPECIFIED - MICROSCOPIC HEMATURIA
747.62 RENAL VESSEL ANOMALY
785.9 OTHER SYMPTOMS INVOLVING CARDIOVASCULAR SYSTEM
794.4 NONSPECIFIC ABNORMAL RESULTS OF FUNCTION STUDY OF KIDNEY
863.0 - 863.99
INJURY TO STOMACH WITHOUT OPEN WOUND INTO CAVITY - INJURY TO OTHER AND UNSPECIFIED GASTROINTESTINAL SITES WITH OPEN WOUND INTO CAVITY
864.00 - 864.19
UNSPECIFIED INJURY TO LIVER WITHOUT OPEN WOUND INTO CAVITY - OTHER INJURY TO LIVER WITH OPEN WOUND INTO CAVITY
865.00 - 865.19
UNSPECIFIED INJURY TO SPLEEN WITHOUT OPEN WOUND INTO CAVITY - OTHER INJURY TO SPLEEN WITH OPEN WOUND INTO CAVITY
868.00 - 868.19
INJURY TO UNSPECIFIED INTRA-ABDOMINAL ORGAN WITHOUT OPEN WOUND INTO CAVITY - INJURY TO OTHER AND MULTIPLE INTRA-ABDOMINAL ORGANS WITH OPEN WOUND INTO CAVITY
902.40 INJURY TO RENAL VESSEL(S) UNSPECIFIED
959.12 OTHER INJURY OF ABDOMEN
959.8 OTHER AND UNSPECIFIED INJURY TO OTHER SPECIFIED SITES INCLUDING MULTIPLE
996.1 MECHANICAL COMPLICATION OF OTHER VASCULAR DEVICE IMPLANT AND GRAFT
996.81 COMPLICATIONS OF TRANSPLANTED KIDNEY
998.11 HEMORRHAGE COMPLICATING A PROCEDURE
V42.0 KIDNEY REPLACED BY TRANSPLANT
V42.7 LIVER REPLACED BY TRANSPLANT
V42.83 PANCREAS REPLACED BY TRANSPLANT
V58.44 AFTERCARE FOLLOWING ORGAN TRANSPLANT
Group 1 Medical Necessity ICD-9 Codes Asterisk Explanation:
** apply to abdominal aortography only.
ICD-9 Codes that DO NOT Support Medical Necessity
N/A
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