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
- 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
- ICD-9-CM codes:
- 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
- ICD-9-CM Codes:
- 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
- ICD-9-CM Codes:
- Typical Symptoms: Identifying appropriate patients for Corus® CAD