932 Chest Imaging CPT, HCPCS and Diagnoses Codes

[Pages:40]Medical Policy Chest Imaging CPT, HCPCS and Diagnoses Codes

Policy Number: 932

BCBSA Reference Number: N/A NCD/LCD: N/A

Related Policies

? Medicare Advantage: Advanced Imaging/Radiology and Sleep Disorder Management Clinical and Utilization Guidance Redirect, #923

? Advanced Imaging/Radiology CPT and HCPCS Codes, #900 ? Advanced Imaging/Radiology, #968 ? Oncologic Imaging CPT, HCPCS and Diagnoses Codes, #929 ? Abdomen and Pelvic Imaging CPT, HCPCS and Diagnoses Codes, #930 ? Brain Imaging CPT, HCPCS and Diagnoses Codes, #931 ? Extremity Imaging CPT, HCPCS and Diagnoses Codes, #933 ? Head and Neck Imaging CPT, HCPCS and Diagnoses Codes, #934 ? Spine Imaging CPT, HCPCS and Diagnoses Codes, #935 ? Vascular Imaging CPT, HCPCS and Diagnoses Codes, #936

Table of Contents

Commercial Products .................................................................................................................................... 1 Medicare Advantage Products ...................................................................................................................... 1 CPT Codes / HCPCS Codes / ICD Codes .................................................................................................... 2 CPT Codes: 71250, 71260, 71270 Chest CT ............................................................................................... 2 CPT Codes: 71550, 71551, 71552 MRI chest ............................................................................................ 21 CPT Codes: 78811, 78812, 78813, 78814, 78815, 78816 PET imaging ................................................... 40 CPT Codes: 77046, 77047, 77048, 77049 MRI breast............................................................................... 40 Policy History .............................................................................................................................................. 40 Disclaimer:................................................................................................................................................... 40

Commercial Products

The following CPT and HCPCS codes are in-scope under the AIM Advanced Imaging/Radiology Management Program for Commercial Managed Care (HMO and POS) and Commercial PPO and EPO. For medical necessity criteria, see AIM Clinical Appropriateness Guidelines for Advanced Imaging/Radiology.

Medicare Advantage Products

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The following CPT and HCPCS codes are in-scope under the AIM Advanced Imaging/Radiology Management Program for Medicare HMO and PPO. For medical necessity criteria, see AIM Clinical Appropriateness Guidelines for Advanced Imaging/Radiology.

CPT Codes / HCPCS Codes / ICD Codes

Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable.

The following codes are included below for informational purposes only; this is not an all-inclusive list.

CPT Codes: 71250, 71260, 71270 Chest CT

CPT codes Code Description

71250

Chest CT without contrast

71260

Chest CT with contrast

71270

Chest CT without contrast, followed by re-imaging with contrast

ICD-10 Diagnoses Codes

ICD-10

Code Description

A01.03

Typhoid pneumonia

A02.22

Salmonella pneumonia

A02.9

Salmonella infection, unspecified

A06.5

Amebic lung abscess

A15.0

Tuberculosis of lung

A15.4

Tuberculosis of intrathoracic lymph nodes

A15.5

Tuberculosis of larynx, trachea and bronchus

A15.6

Tuberculous pleurisy

A15.7

Primary respiratory tuberculosis

A15.8

Other respiratory tuberculosis

A15.9

Respiratory tuberculosis unspecified

A18.84

Tuberculosis of heart

A20.2

Pneumonic plague

A21.2

Pulmonary tularemia

A22.1

Pulmonary anthrax

A24.1

Acute and fulminating melioidosis

A31.0

Pulmonary mycobacterial infection

A37.01

Whooping cough due to Bordetella pertussis with pneumonia

A37.11

Whooping cough due to Bordetella parapertussis with pneumonia

A37.81

Whooping cough due to other Bordetella species with pneumonia

A37.91

Whooping cough, unspecified species with pneumonia

A39.50

Meningococcal carditis, unspecified

A39.51

Meningococcal endocarditis

A39.52

Meningococcal myocarditis

A39.53

Meningococcal pericarditis

A40.3

Sepsis due to Streptococcus pneumoniae

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A42.0 A43.0 A50.04 A52.72 A52.73 A53.9 A54.84 A69.8 A70 A78 B01.2 B05.2 B06.81 B20 B25.0 B37.1 B37.81 B38.0 B38.1 B38.2 B38.89 B38.9 B39.0 B39.1 B39.2 B39.9 B44.0 B44.1 B44.81 B44.89 B44.9 B45.0 B45.8 B45.9 B58.3 B59 B65.9 B77.81 B95.3 B97.21 B97.29 B97.35 B97.4 B99.8

Pulmonary actinomycosis Pulmonary nocardiosis Early congenital syphilitic pneumonia Syphilis of lung and bronchus Symptomatic late syphilis of other respiratory organs Syphilis, unspecified Gonococcal pneumonia Other specified spirochetal infections Chlamydia psittaci infections Q fever Varicella pneumonia Measles complicated by pneumonia Rubella pneumonia Human immunodeficiency virus [HIV] disease Cytomegaloviral pneumonitis Pulmonary candidiasis Candidal esophagitis Acute pulmonary coccidioidomycosis Chronic pulmonary coccidioidomycosis Pulmonary coccidioidomycosis, unspecified Other forms of coccidioidomycosis Coccidioidomycosis, unspecified Acute pulmonary histoplasmosis capsulati Chronic pulmonary histoplasmosis capsulati Pulmonary histoplasmosis capsulati, unspecified Histoplasmosis, unspecified Invasive pulmonary aspergillosis Other pulmonary aspergillosis Allergic bronchopulmonary aspergillosis Other forms of aspergillosis Aspergillosis, unspecified Pulmonary cryptococcosis Other forms of cryptococcosis Cryptococcosis, unspecified Pulmonary toxoplasmosis Pneumocystosis Schistosomiasis, unspecified Ascariasis pneumonia Streptococcus pneumoniae as the cause of diseases classified elsewhere SARS-associated coronavirus as the cause of diseases classified elsewhere Other coronavirus as the cause of diseases classified elsewhere Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified eRlesespwirhaetroery syncytial virus as the cause of diseases classified elsewhere Other infectious disease

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B99.9 D86.0 D86.1 D86.2 D86.85 D86.89 D86.9 F17.200 F17.201 F17.210 F17.211 F17.213 F17.218 F17.219 G00.1 G13.0 G25.82 G54.0 G70.00 G70.01 G70.80 G70.81 G73.1 G81.90 G81.91 G81.92 G81.93 G81.94 G90.2 H53.9 I00 I05.0 I05.1 I05.2 I10 I16.0 I16.1 I16.9 I25.10 I25.110 I25.111 I25.118 I25.119 I26.01

Unspecified infectious disease Sarcoidosis of lung Sarcoidosis of lymph nodes Sarcoidosis of lung with sarcoidosis of lymph nodes Sarcoid myocarditis Sarcoidosis of other sites Sarcoidosis, unspecified Nicotine dependence, unspecified, uncomplicated Nicotine dependence, unspecified, in remission Nicotine dependence, cigarettes, uncomplicated Nicotine dependence, cigarettes, in remission Nicotine dependence, cigarettes, with withdrawal Nicotine dependence, cigarettes, with other nicotine-induced disorders Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders Pneumococcal meningitis Paraneoplastic neuromyopathy and neuropathy Stiff-man syndrome Brachial plexus disorders Myasthenia gravis without (acute) exacerbation Myasthenia gravis with (acute) exacerbation Lambert-Eaton syndrome, unspecified Lambert-Eaton syndrome in disease classified elsewhere Lambert-Eaton syndrome in neoplastic disease Hemiplegia, unspecified affecting unspecified side Hemiplegia, unspecified affecting right dominant side Hemiplegia, unspecified affecting left dominant side Hemiplegia, unspecified affecting right nondominant side Hemiplegia, unspecified affecting left nondominant side Horner's syndrome Unspecified visual disturbance Rheumatic fever without heart involvement Rheumatic mitral stenosis Rheumatic mitral insufficiency Rheumatic mitral stenosis with insufficiency Essential (primary) hypertension Hypertensive urgency Hypertensive emergency Hypertensive crisis, unspecified Atherosclerotic heart disease of native coronary artery without angina pectoris Atherosclerotic heart disease of native coronary artery with unstable angina pectoris Atherosclerotic heart disease of native coronary artery with angina pectoris with dAothceurmosecnlteerdotsicpahsemart disease of native coronary artery with other forms of angina pAethcetororissclerotic heart disease of native coronary artery with unspecified angina pectoris Septic pulmonary embolism with acute cor pulmonale

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I26.02 I26.09 I26.90 I26.92 I26.93 I26.94 I26.99 I27.0 I27.20 I27.21 I27.22 I27.23 I27.24 I27.29 I27.82 I30.1 I40.0 I42.4 I50.1 I71.00 I71.01 I71.1 I71.2 I71.8 I71.9 I77.6 I87.1 I89.8 I95.0 I95.1 I95.2 I95.3 I95.81 I95.89 I95.9 J06.9 J09.X1 J09.X2 J09.X9 J12.0 J12.1 J12.2 J12.3 J12.81

Saddle embolus of pulmonary artery with acute cor pulmonale Other pulmonary embolism with acute cor pulmonale Septic pulmonary embolism without acute cor pulmonale Saddle embolus of pulmonary artery without acute cor pulmonale Single subsegmental pulmonary embolism without acute cor pulmonale Multiple subsegmental pulmonary emboli without acute cor pulmonale Other pulmonary embolism without acute cor pulmonale Primary pulmonary hypertension Pulmonary hypertension, unspecified Secondary pulmonary arterial hypertension Pulmonary hypertension due to left heart disease Pulmonary hypertension due to lung diseases and hypoxia Chronic thromboembolic pulmonary hypertension Other secondary pulmonary hypertension Chronic pulmonary embolism Infective pericarditis Infective myocarditis Endocardial fibroelastosis Left ventricular failure, unspecified Dissection of unspecified site of aorta Dissection of thoracic aorta Thoracic aortic aneurysm, ruptured Thoracic aortic aneurysm, without rupture Aortic aneurysm of unspecified site, ruptured Aortic aneurysm of unspecified site, without rupture Arteritis, unspecified Compression of vein Other specified noninfective disorders of lymphatic vessels and lymph nodes Idiopathic hypotension Orthostatic hypotension Hypotension due to drugs Hypotension of hemodialysis Postprocedural hypotension Other hypotension Hypotension, unspecified Acute upper respiratory infection, unspecified Influenza due to identified novel influenza A virus with pneumonia Influenza due to identified novel influenza A virus with other respiratory manifestations Influenza due to identified novel influenza A virus with other manifestations Adenoviral pneumonia Respiratory syncytial virus pneumonia Parainfluenza virus pneumonia Human metapneumovirus pneumonia Pneumonia due to SARS-associated coronavirus

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J12.89 J12.9 J13 J14 J15.0 J15.1 J15.20 J15.211 J15.212 J15.29 J15.3 J15.4 J15.5 J15.6 J15.7 J15.8 J15.9 J16.0 J16.8 J17 J18.0 J18.1 J18.2 J18.8 J18.9 J22 J39.8 J41.0 J41.1 J41.8 J42 J43.0 J43.1 J43.2 J43.8 J43.9 J44.0 J44.1 J44.9 J47.0 J47.1 J47.9 J60 J61

Other viral pneumonia Viral pneumonia, unspecified Pneumonia due to Streptococcus pneumoniae Pneumonia due to Hemophilus influenzae Pneumonia due to Klebsiella pneumoniae Pneumonia due to Pseudomonas Pneumonia due to staphylococcus, unspecified Pneumonia due to Methicillin susceptible Staphylococcus aureus Pneumonia due to Methicillin resistant Staphylococcus aureus Pneumonia due to other staphylococcus Pneumonia due to streptococcus, group B Pneumonia due to other streptococci Pneumonia due to Escherichia coli Pneumonia due to other Gram-negative bacteria Pneumonia due to Mycoplasma pneumoniae Pneumonia due to other specified bacteria Unspecified bacterial pneumonia Chlamydial pneumonia Pneumonia due to other specified infectious organisms Pneumonia in diseases classified elsewhere Bronchopneumonia, unspecified organism Lobar pneumonia, unspecified organism Hypostatic pneumonia, unspecified organism Other pneumonia, unspecified organism Pneumonia, unspecified organism Unspecified acute lower respiratory infection Other specified diseases of upper respiratory tract Simple chronic bronchitis Mucopurulent chronic bronchitis Mixed simple and mucopurulent chronic bronchitis Unspecified chronic bronchitis Unilateral pulmonary emphysema [MacLeod's syndrome] Panlobular emphysema Centrilobular emphysema Other emphysema Emphysema, unspecified Chronic obstructive pulmonary disease with acute lower respiratory infection Chronic obstructive pulmonary disease with (acute) exacerbation Chronic obstructive pulmonary disease, unspecified Bronchiectasis with acute lower respiratory infection Bronchiectasis with (acute) exacerbation Bronchiectasis, uncomplicated Coalworker's pneumoconiosis Pneumoconiosis due to asbestos and other mineral fibers

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J62.0 J62.8 J63.0 J63.1 J63.2 J63.3 J63.4 J63.5 J63.6 J64 J65 J66.0 J66.8 J67.0 J67.1 J68.0 J68.1 J68.2 J68.3 J68.4 J68.8 J68.9 J69.0 J69.1 J69.8 J70.0 J70.1 J70.2 J70.3 J70.4 J70.5 J70.8 J70.9 J82.81 J82.82 J82.83 J82.89 J84.01 J84.02 J84.03 J84.09 J84.10 J84.111 J84.112

Pneumoconiosis due to talc dust Pneumoconiosis due to other dust containing silica Aluminosis (of lung) Bauxite fibrosis (of lung) Berylliosis Graphite fibrosis (of lung) Siderosis Stannosis Pneumoconiosis due to other specified inorganic dusts Unspecified pneumoconiosis Pneumoconiosis associated with tuberculosis Byssinosis Airway disease due to other specific organic dusts Farmer's lung Bagassosis Bronchitis and pneumonitis due to chemicals, gases, fumes and vapors Pulmonary edema due to chemicals, gases, fumes and vapors Upper respiratory inflammation due to chemicals, gases, fumes and vapors, not eOlstheewrhaecrueteclaanssdifsieudbacute respiratory conditions due to chemicals, gases, fumes and vCahproornsic respiratory conditions due to chemicals, gases, fumes and vapors Other respiratory conditions due to chemicals, gases, fumes and vapors Unspecified respiratory condition due to chemicals, gases, fumes and vapors Pneumonitis due to inhalation of food and vomit Pneumonitis due to inhalation of oils and essences Pneumonitis due to inhalation of other solids and liquids Acute pulmonary manifestations due to radiation Chronic and other pulmonary manifestations due to radiation Acute drug-induced interstitial lung disorders Chronic drug-induced interstitial lung disorders Drug-induced interstitial lung disorders, unspecified Respiratory conditions due to smoke inhalation Respiratory conditions due to other specified external agents Respiratory conditions due to unspecified external agent Chronic eosinophilic pneumonia Acute eosinophilic pneumonia Eosinophilic asthma Other pulmonary eosinophilia, not elsewhere classified Alveolar proteinosis Pulmonary alveolar microlithiasis Idiopathic pulmonary hemosiderosis Other alveolar and parieto-alveolar conditions Pulmonary fibrosis, unspecified Idiopathic interstitial pneumonia, not otherwise specified Idiopathic pulmonary fibrosis

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J84.113 J84.114 J84.115 J84.116 J84.117 J84.170

J84.178 J84.2 J84.81 J84.82 J84.83 J84.841 J84.842 J84.843 J84.848 J84.89 J84.9 J85.0 J85.1 J85.2 J85.3 J86.0 J86.9 J90 J91.0 J91.8 J92.0 J93.0 J93.11 J93.12 J93.81 J93.82 J93.83 J93.9 J94.0 J94.1 J94.2 J94.8 J94.9 J95.1 J95.2 J95.3 J95.4 J95.811

Idiopathic non-specific interstitial pneumonitis Acute interstitial pneumonitis Respiratory bronchiolitis interstitial lung disease Cryptogenic organizing pneumonia Desquamative interstitial pneumonia Interstitial lung disease with progressive fibrotic phenotype in diseases classified elsewhere Other interstitial pulmonary diseases with fibrosis in diseases classified elsewhere Lymphoid interstitial pneumonia Lymphangioleiomyomatosis Adult pulmonary Langerhans cell histiocytosis Surfactant mutations of the lung Neuroendocrine cell hyperplasia of infancy Pulmonary interstitial glycogenosis Alveolar capillary dysplasia with vein misalignment Other interstitial lung diseases of childhood Other specified interstitial pulmonary diseases Interstitial pulmonary disease, unspecified Gangrene and necrosis of lung Abscess of lung with pneumonia Abscess of lung without pneumonia Abscess of mediastinum Pyothorax with fistula Pyothorax without fistula Pleural effusion, not elsewhere classified Malignant pleural effusion Pleural effusion in other conditions classified elsewhere Pleural plaque with presence of asbestos Spontaneous tension pneumothorax Primary spontaneous pneumothorax Secondary spontaneous pneumothorax Chronic pneumothorax Other air leak Other pneumothorax Pneumothorax, unspecified Chylous effusion Fibrothorax Hemothorax Other specified pleural conditions Pleural condition, unspecified Acute pulmonary insufficiency following thoracic surgery Acute pulmonary insufficiency following nonthoracic surgery Chronic pulmonary insufficiency following surgery Chemical pneumonitis due to anesthesia Postprocedural pneumothorax

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