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October 5, 2015 - Updated: 09.30.16

Corus CAD Test Coding and Billing Guidelines (CM00021, V3)

The MolDX has completed the Corus® CAD Gene Expression technical assessment and determined that the test meets criteria for analytical and clinical validity, and clinical utility as a reasonable and necessary Medicare benefit. Effective 01/01/2012, MolDX will reimburse services for Corus® CAD.

To report a Corus® CAD service, submit the following claim information:

  • CPT code 81479 – unlisted molecular pathology procedure
  • Enter appropriate "Z - Code™  identifier" in the comment/narrative field for the following claim field/types:
  • Loop 2300 NTE 01 for Part A or Loop 2400 or SV101 - 7 field  for Part B
  • Form locator 80 for Part A or Box 19 for Part B paper claim (Note: only one test/one identifier may be submitted per paper claim)
  • Select at least one diagnosis code
    1. Typical Symptoms: Identifying appropriate patients for Corus® CAD
      • ICD-9-CM codes:
        • 413.0 Angina decubitus
        • 413.1 Prinzmetal angina; variant angina pectoris
        • 413.9 Other and unspecified angina pectoris
        • 786.05 Shortness of breath
        • 786.50 Unspecified chest pain
        • 786.51 Precordial pain
        • 786.59 Other chest pain; discomfort, pressure, tightness in chest
      • ICD-10-CM codes:
        • I20.1 Angina pectoris with documented spasm
        • I20.8 Other forms of angina pectoris
        • I20.9 Angina pectoris, unspecified
        • R06.02 Shortness of breath
        • R07.2 Precordial pain
        • R07.82 Intercostal pain
        • R07.89 Other chest pain
        • R07.9 Chest pain, unspecified
    2. Atypical Symptoms: Require at least one CAD risk factor from List III below
      • ICD-9-CM Codes:
        • 724.5 Backache unspecified; acute or chronic pain located in posterior region of thorax, lumbosacral region or adjacent regions
        • 780.4 Dizziness; light - headedness
        • 780.79 Other malaise and fatigue; lethargy; tiredness
        • 785.1 Palpitations; awareness of heart beat
        • 787.01 Nausea with vomiting
        • 787.02 Nausea alone
        • 787.03 Vomiting alone
        • 787.1 Heartburn
        • 789.00 Abdominal pain
      • ICD-10-CM Codes:
        • M54.9 Dorsalgia, unspecified
        • M79.602 Pain in left arm
        • M79.622 Pain in left upper arm
        • R00.2 Palpitations
        • R10.9 Unspecified abdominal pain
        • R11.0 Nausea
        • R11.2 Nausea with vomiting, unspecified
        • R12 Heartburn
        • R42 Dizziness and giddiness
        • R53.81 Other malaise
        • R68.84 Jaw pain
    3. Common CAD Risk Factors: Patient must have at least one atypical symptom from List II above, in addition to at least one risk factor listed below
      • ICD-9-CM Codes:
        • 272.0 Hypercholesterolemia
        • 272.1 Hyperglyceridemia
        • 272.2 Hyperlipidemia, mixed
        • 272.4 Hyperlipidemia, other and unspecified
        • 277.7 Dysmetabolic syndrome X
        • 278.00 Obesity
        • 278.01 Obesity, morbid
        • 305.1 Tobacco use disorder; tobacco dependence
        • 401.1 Essential hypertension, benign
        • 401.9 Essential hypertension, unspecified
        • 414.01 Coronary atherosclerosis of native coronary artery
        • 433.10 Occlusion and stenosis of carotid artery
        • 437.0 Cerebral atherosclerosis
        • 440.0 Atherosclerosis of the aorta
        • 440.1 Atherosclerosis of the renal artery
        • 440.20 Atherosclerosis of native arteries of the extremities
        • V15.82 Tobacco use, history
        • Female > 60
        • Male > 50
        • V17.3 Family history of ischemic heart disease
        • V17.41 Family history of sudden cardiac death
      • ICD-10-CM Codes:
        • E66.9 Obesity, unspecified
        • E78.0 Pure hypercholesterolemia(end dated 09/30/2016)
        • E78.00-Pure hypercholesterolemia, unspecified
        • E78.01-familial hypercholesterolemia
        • E78.1 Pure hyperglyceridemia
        • E78.2 Mixed hyperlipidemia
        • E78.4 Other hyperlipidemia
        • E78.5 Hyperlipidemia, unspecified
        • E88.81 Metabolic syndrome
        • F17.200 Nicotine dependence, unspecified uncomplicated
        • F17.201 Nicotine dependence unspecified, in remission
        • F17.210 Nicotine dependence, cigarettes, uncomplicated
        • F17.211 Nicotine dependence, cigarettes, in remission
        • F17.220 Nicotine dependence, chewing tobacco, uncomplicated
        • F17.221 Nicotine dependence, chewing tobacco, in remission
        • F17.290 Nicotine dependence, other tobacco product, uncomplicated
        • F17.291 Nicotine dependence, other tobacco product, in remission
        • I10 Essential (primary) hypertension
        • I25.111 Atherosclerosis heart disease of native coronary artery with angina pectoris with documented spasm
        • I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
        • I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
        • I65.21 Occlusion and stenosis of right carotid artery
        • I65.22 Occlusion and stenosis of left carotid artery
        • I65.23 Occlusion and stenosis of bilateral carotid artery
        • I67.2 Cerebral atherosclerosis
        • I70.1 Atherosclerosis of the renal artery
        • I70.201 Unspecified atherosclerosis of native arteries of the extremities, right leg
        • I70.202 Unspecified atherosclerosis of native arteries of extremities, left leg
        • I70.203 Unspecified atherosclerosis of native arteries of extremities, bilateral legs
        • I70.208 Unspecified atherosclerosis of native arteries of extremities, other extremity
        • I70.209 Unspecified atherosclerosis of native arteries of extremities, unspecified extremity
        • Z82.41 Family history of sudden cardiac death
        • Z82.49 Family history of ischemic heart disease
        • Z87.891 Personal history of nicotine dependence

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