CPT CODE 84443, J9045 Thyroid stimulating hormone (TSH)

cpt code and description

84443 - Thyroid stimulating hormone (TSH)  - average fee amount  - $30  - $40

J9045 - Injection, carboplatin, 50 mg 


THYROID TESTING

Total T4

Free T4

TSH

T3 Uptake


CMS (Medicare) has determined that Thyroid Testing (CPT Codes 84436, 84439, 84443, 84479) is only medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are ordering this test for a diagnostic condition other than those listed below, please have your patient sign and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with the documentation in the patient’s medical records for the date of service. 


Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitary glands. These abnormalities may be either primary or secondary and often but not always accompany clinically defined signs and symptoms indicative of thyroid dysfunction.

Laboratory evaluation of thyroid function has become more scientifically defined. Tests can be done with increased specificity, thereby reducing the number of tests needed to diagnose and follow treatment of most thyroid disease. Measurements of serum sensitive thyroid-stimulating hormone (TSH) levels, complemented by determination of thyroid hormone levels [free thyroxine (fT-4) or total thyroxine (T4) with Triiodothyronine (T3) uptake] are used for diagnosis and follow-up of patients with thyroid disorders.

Additional tests may be necessary to evaluate certain complex diagnostic problems or on hospitalized patients, where many circumstances can skew tests results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) or T3 uptake is performed, calculation of the free thyroxine index (FTI) is useful to correct for abnormal results for either total T4 or T3 uptake due to protein binding effects.

UnitedHealthcare Community Plan reimburses for Thyroid Testing (CPT codes 84436, 84439, 84443, and 84479), when the claim indicates a code found on the list of approved diagnosis codes for this test.

UnitedHealthcare Community Plan will not reimburse when the treatment rendered is without inclusion of one of the ICD-9-CM and ICD-10CM diagnostic codes being included on the claim accurately reflecting the member's condition.


UnitedHealthcare Community Plan ICD-9 Codes approved with CPT codes 84436, 84439, 84443, and/or 84479 (Thyroid Testing)

List of ICD-9 codes for which CPT codes 84436, 84439, 84443, and/or 84479 will be reimbursed. UnitedHealthcare Community Plan ICD-10 Codes approved with CPT codes 84436, 84439, 84443, and/or 84479 (Thyroid Testing) (Effective 10/1/15) List of ICD-10 codes for which CPT codes 84436, 84439, 84443, and/or 84479 will be reimbursed. UnitedHealthcare Community Plan ICD-9 Codes approved with CPT codes 85610 Prothrombin Time (PT) List of ICD-9 codes for which CPT code 85610 will be reimbursed.

NOTE: Please be aware that it is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis must be present for the procedure to be paid. In addition, the procedure must be reasonable and necessary for that diagnosis. Documentation within the beneficiary's medical record must support the necessity for the test(s) provided for each date of service. For additional information, see the “Limited Coverage Guidebook Information” provided in this section


Indications FOR cpt J9045

Carboplatin may be indicated for use in the following:

ovarian and endometrial carcinoma

small cell and non-small cell lung carcinoma

head and neck tumors

nonseminomatous testicular carcinoma

seminoma

retinoblastoma

primary brain tumors

malignant melanoma

osteogenic and soft tissue sarcomas

prostate, bladder and urothelial malignancies

breast carcinomas

esophageal carcinoma and adenocarcinoma

carcinoma of unknown primary site

fallopian tube and peritoneal carcinomas (of ovarian origin)

Hodgkin's and non-Hodgkin's lymphomas

transitional cell carcinoma of the urethra, ureter and kidney

malignant mesothelioma

cervical carcinomas and carcinoma of female genital organs



Limitations 

It is recommended that Carboplatin be administered to patients under supervision of a physician experienced in cancer chemotherapy. It is also, recommended that equipment and medications (including epinephrine, oxygen, antihistamines and intravenous corticosteroids) necessary for treatment of a possible anaphylactic reaction be readily available each administration of carboplatin.

Payment for the drug and associated services (i.e., rescue agents, chemotherapy) will be denied as not medically necessary (investigational) when used for a disease process not listed above. Therefore claims reported with an ICD-9 code not listed in the “ICD-9 Codes That Support Medical Necessity” section of this policy will be denied. However, because cancer therapy is rapidly evolving and chemotherapeutic protocol evaluation is part of routine care, those claims may be reversed on appeal IF the drug is administered under a formal protocol conducted under the auspices of a National Cancer Center of Excellence. That documentation would be required on appeal.


National Drug Code (NDC) Pricing Reminder

Since October 2010, Blue Cross and Blue Shield of Illinois (BCBSIL) has required that all home infusion/specialty pharmacy drugs be billed with the appropriate National Drug Code (NDC) and NDC-related information (qualifier, unit of measure, number of units, price per unit), in addition to the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) code(s) on professional claims.

Previously, we announced that NDCs would be required effective July 1, 2011, for drugs administered in physician offices and billed on professional claims. However, while working collaboratively with providers and electronic trading partners (billing services and clearinghouses), we understood that more time was needed to prepare in some situations, prior to transitioning to the use of NDCs. For this reason, we postponed implementation of NDC pricing until Sept. 1, 2011.

The above postponement was announced in the News and Updates section of our Provider website on July 12, 2011, and we are moving forward, as planned, with implementation of NDC pricing.

This means that, beginning Sept. 1, 2011, claims must include the NDC and related information (qualifier, unit of measure, number of units, price per unit), along with the appropriate HCPCS or CPT code. Once NDC pricing is implemented on Sept. 1, 2011, claims submitted without NDCs and related information, as required, will no longer be accepted.

To help your office make the transition, we will continue to provide examples of high-volume J codes, and how they “translate” in terms of NDC billing.

THIS MONTH’S NDC BILLING EXAMPLE: J9045



What was administered?

In our example, the patient receives 300 mg of Carboplatin via intravenous infusion. The applicable HCPCS code would be J9045 – Injection, Carboplatin, 50 mg.



What’s on the package label?

There are numerous NDCs available for Carboplatin. Each container label displays the appropriate unit of measure for that drug. Some NDCs represent the drug supplied as a powder in single dose vial where the unit of measure is UN. Other NDCs represent the drug supplied as a liquid where the unit of measure is ML.


What to include on the claim:

When entered on your claim, each NDC must follow the 5digit-4digit-2digit format—any leading zeroes must be added to each segment to make 11 digits total. Please remember to also bill the appropriate NDC for the dilutant, as found on the package label, and any applicable chemotherapy codes 

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