The Procedure to Diagnosis (CPT to ICD-9) Crosswalk has been reinstated effective March 16 , 2007.

 This is the crosswalk that was introduced early in 2006 and was subsequently suspended.  A limited number of ICD-9's have been added (see last page of the LCD)

I will be working with a task force, consisting of representatives from the five states impacted by Traiblazer Health, to put forth our recommendations for ICD-9 and/or CPT changes. In order to make our comments as effective and accurate as possible, your help is needed.

Please share with me any denials for medical necessity due to limited coverage that you may have encountered from Trailblazer Health between January 2006 and March 2006. In offering this information please bear in mind privacy standards and share only the diagnosis/procedure combination denied.   
 
It is critical that your clinics be made aware of the information contained in the crosswalk. Even if a diagnosis would be appropriate for a cap exception, the procedure/modality must FIRST undergo edits per the crosswalk.
 
Link to Trailblazers 2007 LCD: http://www.trailblazerhealth.com/lmrp.asp?ID=4181&lmrptype=tx  

 
Procedure to Diagnosis Edits: http://www.trailblazerhealth.com/partb/LCDAdditional/PM&R%20ICD-9%20CM%20Coding%20List-Y-18AB-R8.htm                                                                         
 
TB Comments to and from providers/suppliers:   http://www.trailblazerhealth.com/partb/LCDSummary/Comment%20Summary%20Y-18%20PM&R1.htm               
 
TB article with summary statement    http://www.trailblazerhealth.com/partb/LCDAdditional/PM&R%20ICD-9%20CM%20Coding%20List-Y-18AB-R8.htm     
 

Thanks in advance for any assistance in this process. As always, questions should be directed to my attention at AngelaSBrooks@....

Angela S. Brooks, PT

VPTA Payer Relations Specialist