ICD-10-CM Diagnosis Codes
ICD-10-PCS Procedure Codes
CPT® Procedure Codes
HCPCS Supply/DME Codes
ICD-9-CM Diagnosis Codes
Place of Service Codes
UB04 Condition Codes
UB04 Revenue Codes
Troponin is useful in the diagnosis of myocardial damage and in estimating the degree of cardiac damage. A blood assay for cardiac markers has promised rapid and accurate detection of acute myocardial infarction (MI). Troponin is a muscle protein that is attached to both actin and tropomyosin. The Troponin regulatory complex consists of three proteins: T, I, and C. The distribution of these isoforms varies between cardiac muscle and slow- and fast-twitch skeletal muscle. Troponin T and I have become better diagnostic markers for acute MI than existing enzymes such as Creatine Kinase isoenzymes (CK-MB) because the new cardiac proteins are distinctly different from skeletal enzymes.
Cardiac Troponin I (cTnI)
· Is highly specific for myocardial tissue
· Is thirteen times more abundant in the myocardium than CK-MB on a weight basis
· Is not detectable in the blood of healthy persons
· Shows a greater proportional increase above the upper limit of the reference interval in patients with MI
· Remains elevated for seven to ten days after an episode of myocardial necrosis.
In addition, measurements of cTnI are useful to clarify which increases in CK-MB are due to myocardial injury and which ones reflect acute or chronic skeletal muscle abnormalities.
Troponin T, the tropomyosin-binding protein of the regulatory complex located on the contractile apparatus of cardiac myocytes, is also a sensitive and specific marker for myocardial necrosis. Damaged heart muscle releases the protein, Troponin T, which increases in the bloodstream as early as 3 hours after the onset of chest pain and remains at an elevated level for 2 to 7 days.
Troponin C is not useful in the management of MI.
Troponin levels are considered medically reasonable and necessary to rule out myocardial injury only under the following conditions:
1. patient presents with signs and symptoms of an acute myocardial infarction (prolonged chest pain often described as squeezing, choking, stabbing, etc., usually spreading across chest to the left arm; dyspnea, diaphoresis) which is confirmed by an electrocardiogram (EKG, ECG);
2. patient presents with vague or atypical symptoms suggestive of a cardiac origin, which is not confirmed by an electrocardiogram;
3. patient evaluation reveals a normal CK-MB; however, the electrocardiogram demonstrates new changes consistent with ischemia (e.g., flipped T waves, ST-segment depression); or
4. to distinguish patients with unstable angina from those with a non-Q wave myocardial infarction.
Initially, if a qualitative Troponin level (procedure code 84512) is performed on a patient with suspected myocardial injury and the results of the qualitative Troponin level are positive, then the quantitative level of Troponin I or Troponin T (procedure code 84484) is performed, usually with the same blood specimen, to determine if the symptoms are cardiac in nature. The Troponin C isoform is not useful in the management of myocardial infarction, and it is not necessary to monitor both the T and I isoform.
The quantitative test is normally performed every 8-12 hours the first 24 hours. Once the determination is made whether myocardial injury has occurred, it is expected that a Troponin level will be performed only when the results are to be used in the active treatment of the patient. It is not necessary to use Troponin in addition to Creatine Kinase (CPT codes 82550-82554) in the management of patients with myocardial infarction.
This LCD does not preclude the use of Creatine Kinase early on in the evaluation of suspected myocardial injury or other symptoms suggestive of a cardiac origin, usually less than 6-8 hours from the onset of symptoms. However, once positive Troponin levels have confirmed the diagnosis of myocardial infarction, routine ordering of both tests is not medically necessary for ongoing monitoring. If both tests are ordered concurrently, the medical records must include documentation of the clinical situation, which warrants the use of both tests.
Title XVIII of the Social Security Act, section 1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.
Title XVIII of the Social Security Act, section 1862(a)(7) excludes routine physical examinations.
Title XVIII of the Social Security Act, section 1862(a)(1)(A) only allows coverage and payment for those services that are considered to be medically reasonable and necessary.
42CFR410.32 states that diagnostic tests may only be ordered by a treating physician (or other treating practitioner acting within the scope of their license and Medicare requirements).
42 CFR 411.15 (a)(1) excludes coverage for routine physical check-ups and examinations performed for a purpose other than treatment or diagnosis of a specific illness, symptom, complaint, or injury.
Contractor Name(Contractor Number) - Contractor Info
06/28/2010 - #19
Revision for consistency (CICS Merge) Changed Contractor Determination Number to PBSI-A-10-078.
This LCD was revised to change the contractor from TriSpan Health Services (00230) to Pinnacle Business Solutions, Inc. (00233) effective October 1, 2009. No coverage criteria were changed for this revision effective date. Refer to Change Request 6590 for additional information.
In accordance with Section 911 of the Medicare Modernization Act of 2003, the Missouri Medicare workload was transitioned to the J5 MAC, Wisconsin Physicians Service (WPS) effective May 1, 2008. This LCD was only revised to remove TriSpan Health Services' Missouri contractor number (00242). The coverage criteria were not revised. As of May 1, 2008, this LCD only applies to Louisiana and Mississippi Part A providers (contractor number 00230).
Added the following codes to the "ICD-9 Codes that Support Medical Necessity": 428.1, 428.21, 428.31, and 428.41.
This existing local medical review policy (LMRP) has been converted to a local coverage determination (LCD). See HOSP 2004-29. All coding provisions, benefit category provisions, and statutory exclusion provisions have been removed.
Added fields include "Medicare Coverage Database ID Number," "Coverage Topic," "Appendices," and "Revision History Number."
The new LCD format no longer includes the following sections:
"CPT/HCPCS Section & Benefit Category"
"Noncovered ICD-9 Codes"
"Not Otherwise Classified (NOC)"
"Reasons for Denial"
Based on CR 2905, this LCD has been revised to exclude inpatient long term care hospitals. Refer to Medicare Bulletin Number HOSP 2004-131 under the "Provider Settings" section for applicable provider settings.
The "Other Comments" section has been revised to include the additional provider settings this LMRP will apply to as outlined change request 1969 and HOSP 2003-30. Bill types 11X, 14X, 18X, and 85X have been added. Bill type 83X has been deleted due to OPPS.
This LCD was converted from an LMRP on 04/29/2004.
09/04/2004 - This policy was updated by the ICD-9 Code Annual Update for 2004-2005.
7/2/2006 - The description for Bill code 14 was changed
10/01/2007 - In accordance with Section 911 of the Medicare Modernization Act of 2003, Missouri was transitioned from FI Trispan Health Services (00230) to FI Trispan Health Services (00242).
2/18/2008 - The description for Bill code 21 was changed
8/1/2010 - The description for Revenue code 0300 was changed
8/1/2010 - The description for Revenue code 0301 was changed
8/1/2010 - The description for Revenue code 0302 was changed
8/1/2010 - The description for Revenue code 0303 was changed
8/1/2010 - The description for Revenue code 0304 was changed
8/1/2010 - The description for Revenue code 0305 was changed
8/1/2010 - The description for Revenue code 0306 was changed
8/1/2010 - The description for Revenue code 0307 was changed
8/1/2010 - The description for Revenue code 0309 was changed
11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
84484 descriptor was changed in Group 1
84512 descriptor was changed in Group 1
08/19/2012 Transition to JH Mac
1. Other Contractor Medical Directors
2. Clinical Diagnosis and Management by Laboratory Methods, 19th Edition,W.B. Saunders Company.
3. Clinical Guide to Laboratory Tests, 3rd Edition, W. B. Saunders Company.
4. American Medical Association, 2009 CPT, Physicians' Current Procedural Terminology, Professional Edition, 2008.
5. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), 6th Edition, Practice Management Information Corporation, 2008.
6. Adams III, Schechtman, K., Landt, Y., Ladenson, J., & Jaffe, A. (1994). Comparable Detection of Acute Myocardial Infarction by Creatine Kinase MB Isoenzyme and Cardiac Troponin I. Clinical Chemistry, 40 (7), 1291-1295.
7. American College of Cardiology/American Heart Association Task Force. (1999). 1999 Update: Guidelines for the management of patients with acute myocardial infarction. Journal of the American College of Cardiology, 34 (3), 890-911.
8. Antman, E., Tanasijevic, M., Thompson, B., et al. (1996). Cardiac-specific Troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. The New England Journal of Medicine, 335 (18), 1342-1349.
9. Braunwald, E. (1992). Heart Disease: A Textbook of Cardiovascular Medicine. (4th ed.). Philadelphia: W. B. Saunders Company.
10. Guest, T., Ramanathan, A., Tuteur, P., Schechtman, K., Labenson, J., & Jaffe, A. (1995). Myocardial injury in critically ill patients. Journal of the American Medical Association, 273 (24), 1945-1949.
11. Hamm, C., Goldmann, B., Heeschen, C., Kreymann, G., Berger, J., & Meinertz, T. (1997). Emergency Room triage of patients with acute chest pain by means of rapid testing for Cardiac Troponin I or Troponin T. The New England Journal of Medicine, 337 (23), 1648-1653.
12. Jacobs, D., DeMott, W., Finley, P., Horvak, R., Kasten, B., & Tilzer, L. (1994). Laboratory Test Handbook (3rd ed.). Hudson: Lexi-Comp Inc.
13. Jaffe, A., Landt, Y., Parvin, C., Abendschein, D., Geltman, E., & Ladenson, J. (1996). Comparative sensitivity of cardiac Troponin I and lactate dehydrogenase isoenzymes for diagnosing acute myocardial infarction. Clinical Chemistry, 42 (11), 1770-1776.
14. Keffer, J. (1997). The cardiac profile and proposed practice guideline for acute ischemic heart disease. Clinical Chemistry, 107(4), 398-409.
15. Lee, T. H., & Goldman, L. (2000). Evaluation of the patient with acute chest pain. The New England Journal of Medicine, 342 (16), 1187-1195.
16. Lindahl, B., Venge, P., & Wallentin, L. (1997). Troponin I identifies patients with unstable Coronary Artery Disease who benefit from long-term antithrombotic protection. Journal of the American College of Cardiology, 29 (1), 43-48.
17. Mair, J. (1997). Cardiac Troponin I and Troponin T: Are enzymes still relevant as cardiac markers? Clinical Chemistry, 99-115.
18. Martins, J., Li, D., Baskin, L., Jialal, I., & Kepper, J. (1996). Comparison of Cardiac Troponin I and Lactate Dehydrogenase Isoenzymes for the late diagnosis of myocardial injury. Clinical Chemistry, 106 (6), 705-708.
19. Ohman, E., Armstrong, P., Christenson, R., et al. (1996). Cardiac Troponin T levels for risk stratification in acute myocardial ischemia. The New England Journal of Medicine, 335 (18), 1333-1341.
20. Polanczyk, C. A., Kuntz, K. M., Sacks, D. B., Johnson, P. A., & Lee, T. H. (1999). Emergency department triage strategies for acute chest pain using creatine kinase-MB and Troponin I assays: A cost-effectiveness analysis. Annals of Internal Medicine, 131 (12), 909-918.
21. Rice, M. S., & MacDonald, D. C. (1999). Appropriate roles of cardiac Troponins in evaluating patients with chest pain. The Journal of the American Board of Family Practice, 12 (3), 214-218.
22. Willerson, J. T. (1995). Cardiovascular Medicine. New York: Churchill Livingstone.
This policy does not reflect the sole opinion of the contractor or the Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from the Contractor Medical Directory Advisory Group.
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.0300 - Laboratory - General Classification
0301 - Laboratory - Chemistry
0302 - Laboratory - Immunology
0303 - Laboratory - Renal Patient (Home)
0304 - Laboratory - Non-Routine Dialysis
0305 - Laboratory - Hematology
0306 - Laboratory - Bacteriology & Microbiology
0307 - Laboratory - Urology
0309 - Laboratory - Other Laboratory
The following short descriptors are in accordance with the AMA copyright. Please refer to the current CPT book for full descriptions.
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
388.70 410.00 410.01 410.02 410.10 410.11 410.12 410.20 410.21 410.22 410.30 410.31 410.32 410.40 410.41 410.42 410.50 410.51 410.52 410.60 410.61 410.62 410.70 410.71 410.72 410.80 410.81 410.82 410.90 410.91 410.92 411.1 413.0 413.1 413.9 427.0 427.1 427.2 427.31 427.32 427.41 427.42 427.5 427.60 427.61 427.69 427.81 427.89 427.9 428.1 428.21 428.31 428.41 526.9 719.41 723.1 729.5 780.01 780.02 780.03 780.09 780.2 780.8 785.0 786.03 786.04 786.05 786.06 786.07 786.09 786.50 786.51 786.52 786.59 787.01 787.02 787.03 789.06 794.31 861.00 861.01 922.1
Any ICD-9-CM code not listed as covered in the "ICD-9 Codes that Support Medical Necessity" section of this determination.