FIRST COAST SERVICE OPTIONS
LOCAL COVERAGE DETERMINATION
CODING GUIDELINES

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Contractor’s Determination Number

J2820

LCD Database ID Number

L29275 – Florida
L29391 – Puerto Rico/Virgin Islands

Contractor Name

First Coast Service Options, Inc.

Contractor Number

09102 – Florida
09202 – Puerto Rico
09302 – Virgin Islands

LCD Title

Sargramostim (GM-CSF, Leukine®)

Coding Guidelines

Claims for GM-CSF should be billed using the following diagnosis codes:

205.00-205.91	Myeloid leukemia
238.71-237.79	Neoplasm of uncertain behavior of other lymphatic and hematopoietic tissues (when GM-CSF is used for Myelodysplastic syndrome (MDS))
288.00-288.09	Neutropenia (when GM-CSF is used for patient with AIDS-associated neutropenia)
995.20	Unspecified adverse effect of unspecified drug, medicinal and biological substance (as primary and when GM-CSF is used for a patient with AZT or Ganciclovir neutropenia.)
995.29	Unspecified adverse effect of other drug, medicinal and biological substance
996.85	Complications of transplanted organ, bone marrow
996.88	Complications of transplanted organ, stem cell
*V42.81	Organ or tissue replaced by transplant, bone marrow
*V42.82	Organ or tissue replaced by transplant, peripheral stem cells
*V42.9	Unspecified organ or tissue replaced by transplant (as secondary when GM-CSF is given to stem cell recipients (e.g., BMT).)
V58.11	Encounter for antineoplastic chemotherapy (when GM-CSF is used for febrile neutropenia resulting from myelosuppressive chemotherapy or following induction or consolidation chemotherapy treatment of adults with AML.)
V58.44	Aftercare following organ transplant (as primary and when GM-CSF is given to stem cell recipients (e.g. BMT).)
*V58.69	Long-term [current] use of other medications (as secondary when GM-CSF is used for a patient with AZT or Ganciclovir neutropenia)
V59.02	Doners blood, stem cells
V59.3	Doners, bone marrow
V59.8	Donors, other specified organ or tissue (when GM-CSF is used in priming for autologous peripheral stem cells (e.g., PBPC), as an adjunct to allogeneic and autologous progenitor-cell transplantation, or for neutrophil engraftment failure.)

* According to the 2005 ICD-9-CM book codes V42.81, V42.82, V42.9 and V58.69 are secondary diagnosis codes and should not be billed as primary. Bill diagnosis code V42.9 with code V58.44. Bill diagnosis code V58.69 with code 995.20 and 995.29.

Other Comments

N/A

Revision History

Date	Revision
10/01/2011	1 – Corrected the parenthetical note under the ICD-9-CM code list and expanded 995.2 to 995.20 and 995.29. Annual 2012 ICD-9-CM Update. Added diagnosis code 996.88. The effective date of this revision is based on date of service.
02/02/2009 – Florida 03/02/2009 – Puerto Rico/Virgin Islands	Original

Document formatted: 09/18/2006 (MPS/et)