2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT
ICD 9 CODE
DESCRIPTION
572.0 286.7 039.2 303.00-303.03 570 207.02 207.00-207.01
ABSCESS OF LIVER ACQUIRED COAGULATION FACTOR DEFICIENCY ACTINOMYCOTIC INFECTIONS, ABDOMINAL ACUTE ALCOHOLIC INTOXICATION ACUTE AND SUBACUTE NECROSIS OF LIVER ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, IN RELAPSE ACUTE ERYTHREMIA AND ERYTHROLEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION
584.6 584.7
ACUTE KIDNEY FAILURE WITH LESION OF RENAL CORTICAL NECROSIS
584.5 584.8 584.9 208.02 208.00-208.01 204.02 204.00-204.01 206.00-206.01 206.02 205.02 205.00-205.01 557.0 453.84 453.82
ACUTE KIDNEY FAILURE WITH LESION OF RENAL MEDULLARY (PAPILLARY) NECROSIS ACUTE KIDNEY FAILURE WITH LESION OF TUBULAR NECROSIS ACUTE KIDNEY FAILURE WITH OTHER SPECIFIED PATHOLOGICAL LESION IN KIDNEY ACUTE KIDNEY FAILURE, UNSPECIFIED ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE ACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION ACUTE LYMPHOID LEUKEMIA, IN RELAPSE ACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION ACUTE MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION ACUTE MONOCYTIC LEUKEMIA, IN RELAPSE ACUTE MYELOID LEUKEMIA, IN RELAPSE ACUTE MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION ACUTE VASCULAR INSUFFICIENCY OF INTESTINE ACUTE VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF UPPER EXTREMITY
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 1 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 453.42 453.41 453.86 453.89 453.87 453.85 453.81 453.40 453.83 357.5 291.0-291.9 273.4 006.0-006.9 277.30 200.60-200.68 022.3 211.7 211.5 211.6 453.0 112.5 230.8 230.7 230.9 086.1 574.00-574.91
ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS ACUTE VENOUS EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS ACUTE VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS
OF UPPER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY ACUTE VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED ALCOHOLIC POLYNEUROPATHY ALCOHOLIC PSYCHOSES ALPHA-1-ANTITRYPSIN DEFICIENCY AMEBIASIS AMYLOIDOSIS, UNSPECIFIED ANAPLASTIC LARGE CELL LYMPHOMA ANTHRAX SEPTICEMIA BENIGN NEOPLASM OF ISLETS OF LANGERHANS BENIGN NEOPLASM OF LIVER AND BILIARY PASSAGES BENIGN NEOPLASM OF PANCREAS, EXCEPT ISLETS OF LANGERHANS
BUDD-CHIARI SYNDROME CANDIDIASIS, DISSEMINATED CARCINOMA IN SITU OF LIVER AND BILIARY SYSTEM CARCINOMA IN SITU OF OTHER AND UNSPECIFIED PARTS OF INTESTINE
CARCINOMA IN SITU OTHER AND UNSPECIFIED DIGESTIVE ORGANS CHAGAS DISEASE WITH ORGAN INVOLVEMENT OTHER THAN HEART CHOLELITHIASIS
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 2 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT
ICD 9 CODE
DESCRIPTION
207.12 207.10-207.11
CHRONIC ERYTHREMIA, IN RELAPSE CHRONIC ERYTHREMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION CHRONIC GLOMERULONEPHRITIS CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION CHRONIC LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE CHRONIC LIVER DISEASE AND CIRRHOSIS CHRONIC LYMPHOID LEUKEMIA, IN RELAPSE CHRONIC LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION CHRONIC MONOCYTIC LEUKEMIA, IN RELAPSE CHRONIC MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION CHRONIC MYELOID LEUKEMIA, IN RELAPSE CHRONIC MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION
582.0-582.9 208.10-208.11 208.12 571.0-571.9 204.12 204.10-204.11 206.12 206.10-206.11 205.12 205.10-205.11 453.74 453.72 453.52 453.51 453.76 453.79 453.77 453.75 453.71
CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF AXILLARY VEINS
CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VEINS OF CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF DISTAL LOWER EXTREMITY CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF DEEP VESSELS OF PROXIMAL LOWER EXTREMITY CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF INTERNAL JUGULAR VEINS CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER SPECIFIED VEINS CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF OTHER THORACIC VEINS CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUBCLAVIAN VEINS
CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF SUPERFICIAL VEINS OF UPPER EXTREMITY
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 3 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 453.50 453.73 121.1 078.5 286.6 269.0 250.00-250.93 032.83 277.4 275.40-275.49 275.01-275.1 275.2 275.3 277.1 588.0-588.9 562.11 562.13 562.01 562.03 304.00-304.93 359.24 122.8 122.0 122.5 122.9 054.0 453.2 453.3
CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED DEEP VESSELS OF LOWER EXTREMITY CHRONIC VENOUS EMBOLISM AND THROMBOSIS OF UPPER EXTREMITY, UNSPECIFIED CLONORCHIASIS CYTOMEGALOVIRAL DISEASE DEFIBRINATION SYNDROME DEFICIENCY OF VITAMIN K DIABETES MELLITUS DIPHTHERITIC PERITONITIS DISORDERS OF BILIURIA EXCRETION DISORDERS OF CALCIUM METABOLISM & OTHER DISORDERS OF CALCIUM METABOLISM DISORDERS OF IRON AND COPPER METABOLISM DISORDERS OF MAGNESIUM METABOLISM DISORDERS OF PHOSPHORUS METABOLISM DISORDERS OF PORPHYRIN METABOLISM DISORDERS RESULTING FROM IMPAIRED RENAL FUNCTION DIVERTICULITIS OF COLON (WITHOUT MENTION OF HEMORRHAGE) DIVERTICULITIS OF COLON WITH HEMORRHAGE DIVERTICULITIS OF SMALL INTESTINE (WITHOUT MENTION OF HEMORRHAGE) DIVERTICULITIS OF SMALL INTESTINE WITH HEMORRHAGE DRUG DEPENDENCE DRUG INDUCED MYOTONIA ECHINOCOCCOSIS, UNSPECIFIED, OF LIVER ECHINOCOCCUS GRANULOSUS INFECTION OF LIVER ECHINOCOCCUS MULTILOCULARIS INFECTION OF LIVER ECHINOCOCCUS, OTHER AND UNSPECIFIED ECZEMA HERPETICUM EMBOLISM AND THROMBOSIS OF INFERIOR VENA CAVA EMBOLISM AND THROMBOSIS OF RENAL VEIN
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 4 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 585.6 027.1 456.0-456.21 456.0-456.21 277.31 121.3 780.66 V67.51 V67.2 V67.1 040.0 271.0 228.04 572.2 130.5 789.1 572.4 054.5 201.00-201.98 042 275.5 252.00-252.02, 252.08 289.4 115.00 590.00-590.9 075 560.0-560.9 782.4 200.70-200.78
END STAGE RENAL DISEASE ERYSIPELOTHRIX INFECTION ESOPHAGEAL VARICES ESOPHAGEAL VARICES FAMILIAL MEDITERRANEAN FEVER FASCIOLIASIS FEBRILE NONHEMOLYTIC TRANSFUSION REACTION FOLLOW-UP EXAMINATION AFTER COMPLETED TREATMENT WITH HIGH-RISK MEDICATIONS, NOT ELSEWHERE CLASSIFIED FOLLOW-UP EXAMINATION, CHEMOTHERAPY FOLLOW-UP EXAMINATION, RADIOTHERAPY GAS GANGRENE GLYCOGENOSIS HEMANGIOMA OF INTRA-ABDOMINAL STRUCTURES HEPATIC ENCEPHALOPATHY HEPATITIS DUE TO TOXOPLASMOSIS HEPATOMEGALY HEPATORENAL SYNDROME HERPETIC SEPTICEMIA HODGKIN’S DISEASE HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE HUNGRY BONE SYNDROME HYPERPARATHYROIDISM HYPERSPLENISM INFECTION BY HISTOPLASMA CAPSULATUM WITHOUT MENTION OF MANIFESTATION INFECTIONS OF KIDNEY INFECTIOUS MONONUCLEOSIS INTESTINAL OBSTRUCTION WITHOUT MENTION OF HERNIA JAUNDICE, UNSPECIFIED, NOT OF NEWBORN LARGE CELL LYMPHOMA
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 5 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 100.0 272.7 027.0 646.70, 646.71, 646.73 V58.61-V58.64, V58.69 088.81 200.00-200.28 209.20-209.27, 209.29 170.0-176.9 150.0-159.9 179-189.9 160.0-165.9 200.80-200.88 263.1 200.40-200.48 200.30-200.38 207.22 207.20-207.21 036.1 036.2 038.12 018.90-018.96 272.2 203.02
LEPTOSPIROSIS ICTEROHEMORRHAGICA LIPIDOSES LISTERIOSIS LIVER DISORDERS IN PREGNANCY LONG-TERM (CURRENT) DRUG USE LYME DISEASE LYMPHOSARCOMA AND RETICULOSARCOMA; BURKITT’S TUMOR OR LYMPHOMA MALIGNANT CARCINOID TUMORS OF OTHER AND UNSPECIFIED SITES MALIGNANT NEOPLASM OF BONE, CONNECTIVE TISSUE, SKIN, AND BREAST MALIGNANT NEOPLASM OF DIGESTIVE ORGANS AND PERITONEUM MALIGNANT NEOPLASM OF GENITOURINARY ORGANS MALIGNANT NEOPLASM OF RESPIRATORY AND INTRATHORACIC ORGANS MALIGNANT TUMORS OF LYMPHATIC TISSUE; OTHER NAMED VARIANTS MALNUTRITION OF MILD DEGREE MANTLE CELL LYMPHOMA MARGINAL ZONE LYMPHOMA MEGAKARYOCYTIC LEUKEMIA, IN RELAPSE MEGAKARYOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION MENINGOCOCCAL ENCEPHALITIS MENINGOCOCCEMIA METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS SEPTICEMIA MILIARY TUBERCULOSIS, UNSPECIFIED MIXED HYPERLIPIDEMIA MULTIPLE MYELOMA, IN RELAPSE
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 6 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 203.00-203.01 072.71 205.32 205.30-205.31 359.22 359.23 359.21 239.0 235.0-236.7, 236.90-236.91, 236.99, 237.0237.6, 237.70237.79, 237.9238.6, 238.71238.76 583.0-583.9 581.0-581.9 305.00-305.93 790.4 V42.7 073.0 268.2 572.8 558.1-558.3, 558.41-558.49, 558.9 277.39 303.90-303.93
MULTIPLE MYELOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION MUMPS HEPATITIS MYELOID SARCOMA, IN RELAPSE MYELOID SARCOMA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION MYOTONIA CONGENITA MYOTONIC CHONDRODYSTROPHY MYOTONIC MUSCULAR DYSTROPHY NEOPLASM OF UNSPECIFIED NATURE OF DIGESTIVE SYSTEM
NEOPLASMS OF UNCERTAIN BEHAVIOR NEPHRITIS AND NEPHROPATHY NOT SPECIFIED AS ACUTE OR CHRONIC NEPHROTIC SYNDROME NON-DEPENDENT ABUSE OF DRUGS NONSPECIFIC ELEVATION OF LEVELS OF TRANSAMINASE OR LACTIC ACID DEHYDROGENASE ORGAN REPLACED BY TRANSPLANT, LIVER ORNITHOSIS, WITH PNEUMONIA OSTEOMALACIA, UNSPECIFIED OTHER SEQUELAE OF CHRONIC LIVER DISEASE OTHER & UNSPECIFIED NONINFECTIOUS GASTROENTERITIS AND COLITIS OTHER AMYLOIDOSIS OTHER AND UNSPECIFIED ALCOHOL DEPENDENCE
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 7 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 272.4 277.6 576.0-576.9 575.0-575.9 573.0-573.9 270.2 203.82 203.80-203.81 208.82 208.80-208.81 238.79 204.82 204.80-204.81 202.80-202.98 202.00-202.68 206.80-206.81 206.82 205.82 205.80-205.81 790.5 084.9 074.8 207.82 207.80-207.81 359.29
OTHER AND UNSPECIFIED HYPERLIPIDEMIA OTHER DEFICIENCIES OF CIRCULATING ENZYMES OTHER DISORDERS OF BILIARY TRACT OTHER DISORDERS OF GALLBLADDER OTHER DISORDERS OF LIVER OTHER DISTURBANCES OF AROMATIC AMINO ACID METABOLISM OTHER IMMUNOPROLIFERATIVE NEOPLASMS, IN RELAPSE OTHER IMMUNOPROLIFERATIVE NEOPLASMS, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE OTHER LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER LYMPHATIC AND HEMATOPOIETIC TISSUES OTHER LYMPHOID LEUKEMIA, IN RELAPSE OTHER LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER LYMPHOMAS; OTHER AND UNSPECIFIED MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE OTHER MALIGNANT NEOPLASMS OF LYMPHOID AND HISTIOCYTIC TISSUE
OTHER MONOCYTIC LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER MONOCYTIC LEUKEMIA, IN RELAPSE OTHER MYELOID LEUKEMIA, IN RELAPSE OTHER MYELOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER NONSPECIFIC ABNORMAL SERUM ENZYME LEVELS OTHER PERNICIOUS COMPLICATIONS OF MALARIA OTHER SPECIFIED DISEASES DUE TO COXSACKIE VIRUS OTHER SPECIFIED LEUKEMIA, IN RELAPSE OTHER SPECIFIED LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION OTHER SPECIFIED MYOTONIC DISORDER
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 8 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 238.8 453.9 569.83 202.70-202.78 567.0-567.29, 567.38-567.9 020.0-020.9 203.12 203.10-203.11 975.0-975.8 964.0-964.9 976.0-976.9
972.0-972.9 973.0-973.6, 973.8, 973.9 969.72 965.00-965.02, 965.09, 965.1, 965.4-965.5, 965.61, 965.69, 965.7-965.9 960.0-960.9 966.0-966.4 969.00 978.0-978.6, 978.8, 978.9 969.71
OTHER SPECIFIED SITES OTHER VENOUS EMBOLISM AND THROMBOSIS OF UNSPECIFIED SITE
PERFORATION OF INTESTINE PERIPHERAL T-CELL LYMPHOMA PERITONITIS PLAGUE PLASMA CELL LEUKEMIA, IN RELAPSE PLASMA CELL LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION POISONING BY AGENTS PRIMARILY ACTING ON THE SMOOTH AND SKELETAL MUSCLES AND RESPIRATORY SYSTEM POISONING BY AGENTS PRIMARILY AFFECTING BLOOD CONSTITUENTS
POISONING BY AGENTS PRIMARILY AFFECTING SKIN AND MUCOUS MEMBRANE, OPHTHALMOLOGICAL, OTORHINOLARYNGOLOGICAL, AND DENTAL DRUGS POISONING BY AGENTS PRIMARILY AFFECTING THE CARDIOVASCULAR SYSTEM POISONING BY AGENTS PRIMARILY AFFECTING THE GI SYSTEM POISONING BY AMPHETAMINES
POISONING BY ANALGESICS, ANTIPYRETICS, AND ANTIRHEUMATICS POISONING BY ANTIBIOTICS POISONING BY ANTICONVULSANTS AND ANTI-PARKINSONISM DRUGS POISONING BY ANTIDEPRESSANT, UNSPECIFIED POISONING BY BACTERIAL VACCINES POISONING BY CAFFEINE
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 9 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 970.0-970.1, 970.81-970.89, 970.9 971.0-971.3, 971.9 979.9 962.0-962.9 969.73 969.01 977.0-977.4, 977.8, 977.9 969.09 961.0-961.9 968.0-968.7, 968.9 969.79 969.8, 969.9 979.0-979.7 963.0-963.5, 963.8, 963.9 969.70 967.0-967.6, 967.8, 967.9 969.02 969.03 969.04 969.1-969.5, 969.6 969.05 974.0-974.7
POISONING BY CNS STIMULANTS POISONING BY DRUGS PRIMARILY AFFECTING THE ANS POISONING BY DRUGS, MEDICINAL, AND BIOLOGICAL SUBSTANCES POISONING BY HORMONES AND SYNTHETIC SUBSTITUTES POISONING BY METHYLPHENIDATE POISONING BY MONOAMINE OXIDASE INHIBITORS POISONING BY OTHER AND UNSPECIFIED DRUGS, AND MEDICINAL SUBSTANCES POISONING BY OTHER ANTIDEPRESSANTS POISONING BY OTHER ANTI-INFECTIVES POISONING BY OTHER CNS DEPRESSANTS AND ANESTHETICS POISONING BY OTHER PSYCHOSTIMULANTS POISONING BY OTHER SPECIFIED AND UNSPECIFIED PSYCHOTROPIC POISONING BY OTHER VACCINES AND BIOLOGICAL SUSTANCES POISONING BY PRIMARILY SYSTEMIC AGENTS POISONING BY PSYCHOSTIMULANT, UNSPECIFIED POISONING BY SEDATIVES AND HYPNOTICS POISONING BY SELECTIVE SEROTONIN & NOREPINEPHRINE REUPTAKE INHIBITORS POISONING BY SELECTIVE SEROTONIN REUPTAKE INHIBITORS POISONING BY TETRACYCLIC ANTIDEPRESSANTS POISONING BY TRANQUILIZERS AND PSYCHODYSLEPTICS (HALLUCINOGENS) POISONING BY TRICYCLIC ANTIDEPRESSANTS POISONING BY WATER, MINERAL, AND URIC ACID METABOLISM DRUGS
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 10 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 572.3 572.1 452 238.77 200.50-200.58 272.0 272.1 555.0-555.9 586 587 268.0 003.1 135 120.9 209.75 209.73 209.71 209.72 209.79 209.74 209.70 091.62 038.0, 038.10038.19, 038.2, 038.3, 038.40038.49, 038.8, 038.9 642.50-642.54 282.60-282.69 238.9 289.52 208.22
PORTAL HYPERTENSION PORTAL PYEMIA PORTAL VEIN THROMBOSIS POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (PTLD) PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA PURE HYPERCHOLESTEROLEMIA PURE HYPERTRIGLYCERIDEMIA REGIONAL ENTERITIS RENAL FAILURE, UNSPECIFIED RENAL SCLEROSIS, UNSPECIFIED RICKETS, ACTIVE SALMONELLA SEPTICEMIA SARCOIDOSIS SCHISTOSOMIASIS, UNSPECIFIED SECONDARY MERKEL CELL CARCINOMA SECONDARY NEUROENDOCRINE TUMOR OF BONE SECONDARY NEUROENDOCRINE TUMOR OF DISTANT LYMPH NODES
SECONDARY NEUROENDOCRINE TUMOR OF LIVER SECONDARY NEUROENDOCRINE TUMOR OF OTHER SITES SECONDARY NEUROENDOCRINE TUMOR OF PERITONEUM SECONDARY NEUROENDOCRINE TUMOR, UNSPECIFIED SITE SECONDARY SYPHILITIC HEPATITIS
SEPTICEMIA SEVERE PRE-ECLAMPSIA SICKLE CELL DISEASE SITE UNSPECIFIED SPLENDID SEQUESTRATION SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, IN RELAPSE
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 11 of 12
2013 NATIONAL COVERAGE DETERMINATION (NCD) CPT CODE(S): 82977
GAMMA GLUTAMYLTRANSFERASE (GGT) DLS TEST CODE AND NAME 172
GAMMA GT DESCRIPTION
ICD 9 CODE 208.20-208.21 204.22 204.20-204.21 206.22
SUBACUTE LEUKEMIA OF UNSPECIFIED CELL TYPE, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION SUBACUTE LYMPHOID LEUKEMIA, IN RELAPSE SUBACUTE LYMPHOID LEUKEMIA, WITHOUT MENTION OF HAVING ACHIEVED REMISSION AND IN REMISSION SUBACUTE MONOCYTIC LEUKEMIA, IN RELAPSE
Source: www.cms.hhs.gov/mcd Effective Date: October 1, 2011
Gamm Glut (GGT) Page 12 of 12
