Download Gamma Glutamyltransferase (GGT)

Gamma Glutamyltransferase (GGT)
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GAMMA GLUTAMYLTRANSFERASE (GGT)
NCD
Source: Program Memorandum AB-02-110, Effective 11-25-02; Medicare NCD Manual, July 2003
Release; October 2003 Release; October 2004 Release; October 2005 Release; October 2006 Release;
Medicare Trans. 1531, Effective 7-1-08, October 2008 Release, January 2008 Release, April 2009
Release, October 2009 Release, October 2010 Release, January 2011 Release
CMS (Medicare) has determined that Gamma Glutamyltransferase (GGT) (CPT Code 82977) is only
medically necessary and, therefore, reimbursable by Medicare when ordered for patients with any of the
diagnostic conditions listed below in the “ICD-9-CM Codes Covered by Medicare Program.” If you are
ordering this test for a diagnostic condition other than those listed below, please have your patient sign
and date an Advanced Beneficiary Notice (ABN). All ICD-9-CM codes provided must be consistent with
the documentation in the patient’s medical records for the date of service.
NOTE: Please be aware that it is not enough to link the procedure code to a correct, payable ICD-9-CM
diagnosis code. The diagnosis must be present for the procedure to be paid. In addition, the procedure
must be reasonable and necessary for that diagnosis. Documentation within the beneficiary's medical
record must support the necessity for the test(s) provided for each date of service. For additional
information, see the “Limited Coverage Guidebook Information” provided in this section.
ICD-9-CM Codes Covered by Medicare Program:
003.1
Salmonella septicemia
006.0-006.9
Amebiasis
014.00-014.86
Tuberculosis of intestines, peritoneum, and mesenteric glands
017.90-017.96
Tuberculosis of other specified organs
018.90-018.96
Miliary tuberculosis, unspecified
020.0-020.9
Plague
022.3
Anthrax septicemia
027.0
Listeriosis
027.1
Erysipelothrix infection
030.1
Tuberculoid leprosy [Type T]
032.83
Diphtheritic peritonitis
036.1
Meningococcal encephalitis
036.2
Meningococcemia
038.0
Septicemia, streptococcal
038.10-038.19
Septicemia, staphylococcal
038.2-038.3
Septicemia, pneumococcal, anaerobes
038.40-038.49
Septicemia due to other gram negative organisms
038.8-038.9
Septicemia – other specified, unspecified
039.2
Actinomycotic infections, abdominal
040.0
Gas gangrene
042
Human immunodeficiency virus (HIV) disease
054.0
Eczema herpeticum
054.5
Herpetic septicemia
060.0-060.1
Yellow fever
070.0-070.9
Viral hepatitis
072.71
Mumps hepatitis
073.0
Ornithosis, with pneumonia
074.8
Other specified diseases due to Coxsackie virus
075
Infectious mononucleosis
078.5
Cytomegaloviral disease
079.99
Unspecified viral infection
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Gamma Glutamyltransferase (GGT)
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082.0-082.3
082.40-082.49
082.8-082.9
084.9
086.1
088.81
091.62
095.3
100.0
112.5
115.00
120.9
121.1
121.3
122.0
122.5
122.8
122.9
130.5
135
150.0-159.9
160.0-165.9
170.0-176.9
179
180.0-184.9
185
186.0-189.9
200.00-202.9
203.02
203.12
203.82
204.02
204.12
204.22
204.82
204.92
205.02
205.12
205.22
205.32
205.82
205.92
206.02
206.12
206.22
206.82
206.92
207.02
207.12
207.22
Tick – borne rickettsioses – spotted fevers, boutonneuse fever, north asian,
queensland tick typhus
Ehrilichiosis
Tick-borne rickettsioses – other specified, unspecified
Other pernicious complications of malaria
Chagas disease with organ involvement other than heart
Lyme disease
Secondary syphilitic hepatitis
Syphilis of liver
Leptospirosis icterohemorrhagica
Candidiasis, disseminated
Infection by Histoplasma capsulatum without mention of manifestation
Schistosomiasis, unspecified
Clonorchiasis
Fascioliasis
Echinococcus granulosus infection of liver
Echinococcus multilocularis infection of liver
Echinococcosis, unspecified, of liver
Echinococcus, other and unspecified
Hepatitis due to toxoplasmosis
Sarcoidosis
Malignant neoplasm of digestive organs and peritoneum
Malignant neoplasm of respiratory and intrathoracic organs
Malignant neoplasm of bone, connective tissue, skin, and breast
Malignant neoplasm of uterus, part unspecified
Malignant neoplasm – cervix uteri, body of uterus, ovary and other uterine adnexa,
oter and unspecified female genital organs
Malignant neoplasm of prostate
Malignant neoplasm – testes, penis and other male genital organs, bladder, kidney
and other and unspecified urinary organs
Malignant neoplasm of lymphatic and hematopoietic tissue
Multiple myeloma in relapse
Plasma cell leukemia in relapse
Other immunoproliferative neoplasms in relapse
Acute lymphoid leukemia in relapse
Chronic lymphoid leukemia in relapse
Subacute lymphoid leukemia in relapse
Other lymphoid leukemia in relapse
Unspecified lymphoid leukemia in relapse
Acute myeloid leukemia in relapse
Chronic myeloid leukemia in relapse
Subacute myeloid leukemia in relapse
Myeloid sarcoma in relapse
Other myeloid leukemia in relapse
Unspecified myeloid leukemia in relapse
Acute monocytic leukemia in relapse
Chronic monocytic leukemia in relapse
Subacute monocytic leukemia in relapse
Other monocytic leukemia in relapse
Unspecified monocytic leukemia in relapse
Acute erythremia and erythroleukemia in relapse
Chronic erythremia in relapse
Megakaryocytic leukemia in relapse
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Gamma Glutamyltransferase (GGT)
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207.82
208.02
208.12
208.22
208.82
208.92
209.20-209.29
209.70
209.71
209.72
209.73
208.74
209.75
209.79
211.5
211.6
211.7
228.04
230.7
230.8
230.9
235.0-236.7
236.90-236.91,
236.99
237.0-237.6
237.70-237.72
*237.73-237.79
237.9
238.0-238.6
238.71-238.79
238.8-238.9
239.0
250.00-250.93
252.00
252.01
252.02
252.08
263.1
263.9
268.0
268.2
269.0
270.2
270.9
271.0
272.0
272.1
272.2
272.4
272.7
272.9
273.4
*275.01-275.09
Other specified leukemia in relapse
Acute leukemia of unspecified cell type in relapse
Chronic leukemia of unspecified cell type in relapse
Subacute leukemia of unspecified cell type in relapse
Other leukemia of unspecified cell type in relapse
Unspecified leukemia of unspecified cell type in relapse
Malignant neuroendocrine tumor
Secondary neuroendocrine tumor, unspecified site
Secondary neuroendocrine tumor of distant lymphnodes
Secondary neuroendocrine tumor of liver
Secondary neuroendocrine tumor of bone
Secondary neuroendocrine tumor of peritoneum
Secondary Merkel cell carcinoma
Secondary neuroendocrine tumor of other sites
Benign neoplasm of liver and biliary passages
Benign neoplasm of pancreas, except islets of Langerhans
Benign neoplasm of islets of Langerhans
Hemangioma of intra-abdominal structures
Carcinoma in situ of other and unspecified parts of intestine
Carcinoma in situ of liver and biliary system
Carcinoma in situ other and unspecified digestive organs
Neoplasms of uncertain behavior – digestive and respiratory systems, genitourinary
organs
Neoplasms of uncertain behavior – other and unspecified urinary organs
Neoplasms of uncertain behavior of endocrine glands and nervous system
Neurofibromatosis
Schwannomatosis, other neurofibromatosis
Other and unspecified parts of nervous system
Neoplasm of uncertain behavior of other and unspecified sites and tissues
Other lymphatic and hematopoetic tissues, (PTLD)
Neoplasms of uncertain behavior – other specified sites, unspecified
Neoplasm of unspecified nature of digestive system
Diabetes mellitus
Hyperparathyroidism, unspecified
Primary hyperparathyroidism
Secondary hyperparathyroidism, non-renal
Other hyperparathyroidism
Malnutrition of mild degree
Unspecified protein-calorie malnutrition
Rickets, active
Osteomalacia, unspecified
Deficiency of vitamin K
Other disturbances of aromatic amino acid metabolism
Unspecified disorder of amino acid metabolism
Glycogenosis
Pure hypercholesterolemia
Pure hyperglyceridemia
Mixed hyperlipidemia
Other and unspecified hyperlipidemia
Lipidoses
Unspecified disorder of lipoid metabolism
Alpha-1-antitrypsin deficiency
Hereditary hemochromatosis, hemochromatosis due to repeated red blood cell
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Gamma Glutamyltransferase (GGT)
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275.1
275.2
275.3
275.40-275.49
275.5
277.1
277.30-277.39
277.4
277.6
282.60-282.69
286.6
286.7
289.4
289.52
291.0-291.5
291.81-291.89
291.9
303.00-303.03
303.90-303.93
304.00-304.93
305.00-305.93
357.5
359.21
359.22
359.23
359.24
359.29
452
453.0-453.3
453.40-453.42
453.6
453.71
453.72
453.73
453.74
453.75
453.76
453.77
453.79
453.81-453.89
453.9
456.0-456.1
456.20-456.21
555.0-555.9
556.0-556.9
557.0
558.1 -558.3
558.41-558.42
558.9
560.0-560.2
transfusions, other hemochromatosis, other disorders of iron metablolism
Disorders of copper metabolism
‘Disorders of magnesium metabolism
Disorders of phosphorus metabolism
Disorders of calcium metabolism
Hungry bone syndrome
Disorders of porphyrin metabolism
Amyloidosis
Disorders of bilirubin excretion
Other deficiencies of circulating enzymes
Sickle cell disease
Defibrination syndrome
Acquired coagulation factor deficiency
Hypersplenism
Splenic sequestration
Alcohol induced mental disorders
Other specified alcohol induced mental disorders – withdrawal, sleep disorders,
anxiety, mood, sexual dysfunction
Unspecified alcohol induced mental disorders
Acute alcoholic intoxication
Other and unspecified alcohol dependence
Drug dependence
Non-dependent abuse of drugs
Alcoholic polyneuropathy
Myotonic muscular dystrophy
Myotonia congenita
Myotonic chondrodystrophy
Drug induced myotonia
Other specified myotonic disorder
Portal vein thrombosis
Other venous embolism and thrombosis – budd chiari, thrombophlebitis migans, of
vena cava, of renal vein
Venous embolism and thrombosis of deep vessels of lower extremity
Venous embolism and thrombosis of superficial vessels of lower extremity
Chronic venous embolism and thrombosis of superficial veins upper extremity
Chronic venous embolism and thrombosis of deep veins upper extremity
Chronic venous embolism and thrombosis of upper extremity unspecified
Chronic venous embolism and thrombosis of axillary veins
Chronic venous embolism and thrombosis of subclavian veins
Chronic venous embolism and thrombosis of internal jugular veins
Chronic venous embolism and thrombosis of other thoracic veins
Chronic venous embolism and thrombosis of other specified veins
Venous embolism and thrombosis of other specified veins
Other venous and embolism thrombosis of unspecified site
Esophageal varices – varicose veins of other sites
Esophageal varices in diseases classified elsewhere
Regional enteritis
Ulcerative colitis
Acute vascular insufficiency of intestine
Other noninfectious gastroenteritis and colitis
Eosinophilic gastroenteritis and colitis
Other and unspecified noninfectious gastroenteritis and colitis
Intestinal obstruction without mention of hernia- intussusception, paralytic ileus,
volvulus
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Gamma Glutamyltransferase (GGT)
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560.30-560.89
560.9
562.01
562.03
562.11
562.13
567.0-567.1
567.21-567.89
567.9
569.83
569.87
570
571.0-571.3
571.40-571.49
571.5-571.9
572.0-572.8
573.0-573.9
574.00-574.91
575.0
575.10-575.12
575.2-575.9
576.0-576.9
581.0-581.3
581.81-581.89
581.9
582.0-582.4
582.81-582.89
582.9
583.0-583.7
583.81-583.89
583.9
584.5-584.9
585.6
586
587
588.0-588.1
588.81-588.89
588.9
590.00-590.11
590.2-590.3
590.80-590.81
Intestinal obstruction without mention of hernia – impaction , other specified
Unspecified intestinal obstruction
Diverticulitis of small intestine (without mention of hemorrhage)
Diverticulitis of small intestine with hemorrhage
Diverticulitis of colon (without mention of hemorrhage)
Diverticulitis of colon with hemorrhage
Peritonitis and retroperitoneal infections – diseases classified elsewhere,
pneumococcal
Other suppurative peritonitis, retropertoneal, other specified
Other disorders of peritoneum
Perforation of intestine
Vomiting of fecal matter
Acute and subacute necrosis of liver
Chronic liver disease and cirrhosis- alcoholic
Chronic liver disease and cirrhosis – chronic hepatitis
Chronic liver disease and cirrhosis – cirrhosis of liver without mention of alcohol,
biliary, other chronic non-alcoholic, unspecified chronic liver disease without mention
of alcohol
Liver abscess and sequelae of chronic liver disease
Other disorders of liver
Cholelithiasis
Other disorders of gallbladder-acute cholecystitis
Other cholecysitis
Other disorders of gallbladder – obstruction, hydrops, perforation, fistula,
cholesterolosis, other specified, unspecified
Other disorders of biliary tract
Nephrotic syndrome- with lesion of proliferative glomerulonephritis, with lesion of
membranous glomerulonephritis, with lesion of membranoproliferative
glomerulonephritis, with lesion of minimal change glomerulonephritis
Nephrotic syndrome – with other specified pathological lesion in kidney
Nephrotic syndrome with unspecified pathological lesion in kidney
Chronic glomerulonephritis- with lesion of: priliferative glomerulonephritis,
membraneous glomerulonephritis, membranoproliferative glomerulonephritis, rapidly
progressive glomerulonephritis
Chronic glomerulonephritis – with other specified pathological lesion in kidney
Chronic glomerulonephritis – with unspecified pathological lesion in kidney
Nephritis and nephropathy, not specified as acute or chronic – with lesion of:
proleiferative glomerulonephritis, membranous glomerulonephritis,
membranoproliferative glomerulonephritis, rapidly progressive glomeulonephritis, renal
cortical necrosis, renal medullary necrosis
Nephritis and nephropathy, not specified as acute or chronic – with other specified
pathological lesion in kidney
Nephritis and nephropathy, not specified as acute or chronic – with unspecified
pathological lesion in kidney
Acute renal failure
End stage renal disease
Renal failure, unspecified
Renal sclerosis, unspecified
Disorders resulting from impaired renal function – renal ostiodystrophy, nephrogenic
diabetes insipidus
Other specified disorders resulting from impaired renal function
Unspecified disorder resulting from impaired renal function
Infections of kidney- chronic pyelonephritis, acute pyelonephritis
Infections of kidney – renal and perinephric abscess, pyeloureteritis cystica
Other pyelonehritis or pyonephrosis, not specified as acute or chronic
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Gamma Glutamyltransferase (GGT)
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590.9
642.50-642.54
Infections of kidney, unspecified
Severe pre-eclampsia
646.70, 646.71,
646.73
782.4
789.1
790.4
790.5
960.0-964.9
Liver disorders in pregnancy
965.00-965.09
965.1-965.5
965.61-965.69
965.7-968.9
969.00-969.09
969.1-969.6
969.70-969.79
969.8-969.9
*970.81-970.89
971.0-979.9
980.0-989.7
989.81-989.89
989.9
V42.7
V58.61-V58.69
V67.1
V67.2
V67.51
Jaundice, unspecified, not of newborn
Hepatomegaly
Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase
Other nonspecific abnormal serum enzyme levels
Poisoning by drugs, medicinal and biological substances – antibiotics, anti-infectives,
hormones and synthetic substitutes, primarily systemic agents, by agents primarily
affecting blood constituents
Poisoning by opiates and related narcotics
Poisoning by salicylates, aromatic analgesics (not elsewhere classified), pyrazole
derivatives
Poisoning by antirheumatics
Poisoning by non-narcotic analgesics, other specified analgesics, unspecified,
anticonvulsants, sedatives, central nervous system depressants
Poisoning by antidepressants; unsp, MAOI, SSNRI,SSRI, Tetracyclic, Tricyclic, other
Poisoning by tranquilizers
Poisoning by psychostimulants; unsp.,caffeine, amphetamines, methylphenidate, other
Poisoning by other specified and or unspecified psychotropes
Other specified central nervous system stimulants, cocaine
Poisoning by central nervous system stimulants; by agents affecting autonomic
nervous, cardiovascular, gastrointestinal. By water, mineral and uric acid metabolism,
agents affecting smooth and skeletal muscle and respiratory, agents affecting skin and
mucosal membrane, other and uspecified, bacterial vaccines, by other vaccines and
biological substances.
Toxic effects of substances chiefly nonmedicinal as to source- alcohol, petroleum
products, solvents (other than petroleum based), corrosive aromatics, acids, alkalis,
lead, other metals, gases, fumes, vapors, noxious substances eaten as food, other
Toxic effects of other substances- asbestos, latex, silicone, tobacco, other
Unspecified substance, chiefly non-medicinal as to source
Organ replaced by transplant, liver
Long term (current) drug use
Follow-up examination, radiotherapy
Follow-up examination, chemotherapy
Follow-up examination after completed treatment with high-risk medications, not
elsewhere classified
ICD-9-CM Codes That May Be Denied or Do Not Support Medical Necessity
Generally, ICD-9-CM codes that are not listed in the “ICD-9-CM Codes Covered by Medicare Program”
section will not be covered because they indicate that the tests are performed for screening purposes or
because they do not support medical necessity.
Frequency Limitations:
When used to assess liver dysfunction secondary to existing non-hepatobiliary disease with no change in
signs, symptoms, or treatment, it is generally not necessary to repeat a GGT determination after a normal
result has been obtained unless new indications are present.
When used to determine if other abnormal enzyme tests reflect liver abnormality rather than other tissue,
it generally is not necessary to repeat a GGT more than one time per week.
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