(Medicare Claims Processing Manual)

When billing for LOCM, SNFs use revenue code 0636.  If the SNF charge for the radiology procedure includes a charge for contrast material, the SNF must adjust the charge for the radiology procedure to exclude any amount for the contrast material.   NOTE:  LOCM is never billed with revenue code 0255 or as part of the radiology procedure.   The A/B MAC (A) will edit for the intrathecal procedure codes and the following codes to determine if payment for LOCM is to be made.  If an intrathecal procedure code is not present, or one of the ICD codes is not present to indicate that a required medic al condition is met, the A/B MAC (A) will deny payment for LOCM.  In these instances, LOCM is not covered and should not be billed to Medicare.  When LOCM Is Separately Billable and Related Coding Requirements    In all intrathecal injections.  HCPCS codes that indicate intrathecal injections are:   70010 70015 72240 72255 72265 72270 72285 72295  One of these must be included on the claim; or    In intravenous and intra -arterial injections only when certain medical conditions are present in an outpatient.  The SNF must verify the existence of at least one of the following medical conditions, and report the applicable diagnosis code(s) either as a principal diagnosis code or other diagnosis codes on the claim:   o A history of previous adverse reaction to contrast material.  The applicable ICD -9-CM codes are V14.8 and V14.9.  The applicable ICD -10-CM codes are Z88.8 and Z88.9.  The conditions which should not be considered adverse reactions are a sensation of heat, flushing, or a single episode of nausea or vomiting.  If the adverse reaction occurs on that visit with the induction of contrast material, codes describing hives, urticar ia, etc. should also be present, as well as a code describing the external cause of injury and poisoning, ICD -9-CM code E947.8.  The applicable ICD -10 CM codes are:  T50.8X5A Adverse effect of diagnostic agents, initial encounter, T50.8X5S Adverse effect of diagnostic agents, sequela , T50.995A Adverse effect of other drugs, medicaments and biological substances, initial encounter, or T50.995S Adverse effect of other drugs, medicaments and biological substances, sequela;   o A history or condition of asthma or allergy.  The applicable ICD -9-CM codes are V07.1, V14.0 through V14.9, V15.0, 493.00, 493.01, 493.10, 493.11, 493.20, 493.21, 493.90, 493.91, 495.0, 495.1, 495.2, 495.3, 495.4, 495.5, 495.6, 495.7, 495.8, 495.9, 995.0, 995.1, 995.2, and 995.3.  The applicable ICD -10-CM codes are in the table below:   ICD-10-CM Codes  J44.0  J44.9  J45.20  J45.22  J45.30  J45.32  J45.40  J45.42  J45.50  J45.52  J45.902  J45.909  J45.998  J67.0  J67.1  JJ67.2  J67.3  J67.4  J67.5  J67.6  J67.7  J67.8  J67.9  J96.00  J96.01  J96.02  J96.90  J96.91  J96.92  T36.0X5A  T36.1X5A  T36.2X5A  T36.3X5A  T36.4X5A  T36.5X5A  T36. 6X5A  T36.7X5A  T36.8X5A  T36.95XA  T37.0X5A  T37.1X5A  T37.2X5A  T37.3X5A  T37.8X5A  T37.95XA  T38.0X5A  T38.1X5A  T38.2X5A  T38.3X5A  T38.4X5A  T38.6X5A  T38.7X5A  T38.805A  T38.815A  T38.895A  T38.905A  T38.995A  T39.015A  T39.095A  T39.1X5A  T39.2X5A  T39.2X5A  T39.315A  T39.395A  T39.4X5A  T39.8X5A  T39.95XA  T40.0X5A  T40.1X5A  T40.2X5A  T40.3X5A  T40.4X5A  T40.5X5A  T40.605A  T40.695A  T40.7X5A  T40.8X5A  T40.905A  T40.995A  T41.0X5A  T41.1X5A  T41.205A  T41.295A  T41.3X5A  T41.4X5A  T41.X5A  T41.5X5A  T42.0X5A  T42.1X5A  T42.2X5A  T42.3X5A  T42.4X5A  T42.5X5A  T42.6X5A  427.5XA  428.X5A  T43.015A  T43.025A  T43.1X5A  T43.205A  T43.215A  T43.225A  T43.295A  T43.3X5A  T43.4X5A  T43.505A  T43.595A  T43.605A  T43.615A  T43.625A  T43.635A  T43.695A  T43.8X5A  T43.95XA  T44.0X5A  T44.1X5A  T44.2X5A  T44.3X5A  T44.6X5A  T44.7X5A  T44.8X5A  T44.905A  T44.995A  T45.0X5A  T45.1X5A  T45.2X5A  T45.3X5A  T45.4X5A  T45.515A  T45.525A  T45.605A  T45.615A  T45.625A  T45.695A  T45.7X5A  T45.8X5A  T45.95XA  T46.0X5A  T46.1X5A  T46.2X5A  T46.3X5A  T46.4X5A  T46.5X5A  T46.6X5A  T46.7X5A  T46.8X5A  T46.905A  T46.995A  T47.0X5A  T47.1X5A  T47.2X5A  T47.3X5A  T47.4X5A  T47.5X5A  T47.6X5A  T47.7X5A  T47.8X5A  T47.95XA  T48.0X5A  T48.1X5A  T48.205A  T48.295A  T48.3X5A  T48.4X5A  T48.5X5A  T48.6X5A  T48.905A  T48.995A  T49.0X5A  T49.1X5A  T49.2X5A  T49.3X5A  T49.4X5A  T49.5X5A  T49.6X5A  T49.6X5A  T47.X5A9  T49.8X5A  T49.95XA  T50.0X5A  T50.1X5A  T50.2X5A  T50.3X5A  T50.4X5A  T50.5X5A  T50.6X5A  T50.7X5A  T50.8X5A  T50.905a  T50.995A  T50.A15A  T50.A25A  T50.A95A  T50.B15A  T50.B95A  T50.Z15A  T50.Z95A  T78.2XXA  T78.3XXA  T78.40XA  T78.41XA  T88.52XA  T88.59XA  T88.6XXA  Z51.89  Z88.0  Z88.1  Z88.2  Z88.3  Z88.4  Z88.5  Z88.6  Z88.7  Z88.8  Z88.9  Z91.010    o Significant cardiac dysfunction including recent or imminent cardiac decompensation, severe arrhythmia, unstable angina pectoris, recent myocardial infarction, and pulmonary hypertension.  The applicable ICD -9-CM codes are:   ICD-9-CM 402.00  402.01  402.10  402.11  402.90  402.91    404.00  404.01  404.02  404.03      404.10  404.11  404.12  404.13      404.90  404.91  404.92  404.93      410.00  410.01  410.02  410.10  410.11  410.12    410.20  410.21  410.22  410.30  410.31  410.32    ICD-9-CM 410.40  410.41  410.42  410.50  410.51  410.52    410.60  410.61  410.62  410.70  410.71  410.72    410.80  410.81  410.82  410.90  410.91  410.92    411.1  415.0  416.0  416.1  416.8  416.9    420.0  420.90  420.91  420.99  424.90  424.91    424.99  427.0  427.1  427.2  427.31  427.32    427.41  427.42  427.5  427.60  427.61  427.69    427.81  427.89  427.9  428.0  428.1  428.9  429.0   429.1  429.2  429.3  429.4  429.5  429.6  429.71   429.79  429.81  429.82  429.89  429.9  785.50  785.51  785.59   o The applicable ICD -10-CM codes are in the table below: