Qualitative Drug Screening (L28145)

LCD for Qualitative Drug Screening (L28145)

Contractor Information

Contractor Number

Number	Type	State(s)
00130	FI	IN
00131	FI	IL
00160	FI	KY
00332	FI	OH
00450	FI	WI
00452	FI	MI
00453	FI	VA, WV
00630	Carrier	IN
00660	Carrier	KY
13101	MAC	CT – Part A
13102	MAC	CT – Part B
13201	MAC	NY – Part A
13202	MAC	NY – Part B
13282	MAC	NY – Part B
13292	MAC	NY – Part B

Contractor Type

Carrier

Fiscal Intermediary

MAC – Part A

MAC- Part B

LCD Information

LCD ID Number

L28145

LCD Title
Qualitative Drug Screening

Contractor's Determination Number
L28145 (R7)

AMA CPT / ADA CDT Copyright Statement
CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

CMS National Coverage Policy
Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act. Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: Title XVIII of the Social Security Act (SSA): Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member. Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim. Code of Federal Regulations: 42 CFR, Section 410.32, indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter). CMS Publications: CMS Publication 100-03, Medicare National Coverage Determinations Manual, Chapter 1: 130.6 Treatment of drug abuse CMS Transmittal No. 653, Publication 100-20, One-Time Notification, Change Request #6852, March 19, 2010, Clinical Laboratory Fee Schedule (CLFS) - Special Instructions for Specific Test Codes (CPT Code 80100, CPT Code 80101, CPT Code 80101QW, G0430, G0430QW, and G0431QW). CMS Transmittal No. 1905, Publication 100-04, Medicare Claims Processing Manual, Change Request #6800, February 5, 2010, New Waived Tests.

Primary Geographic Jurisdiction

Number	Type	State(s)
00130	FI	IN
00131	FI	IL
00160	FI	KY
00332	FI	OH
00450	FI	WI
00452	FI	MI
00453	FI	VA, WV
00630	Carrier	IN
00660	Carrier	KY
13101	MAC	CT – Part A
13102	MAC	CT – Part B
13201	MAC	NY – Part A
13202	MAC	NY – Part B
13282	MAC	NY – Part B
13292	MAC	NY – Part B

Oversight Region

Region I, II, III, V

Original Determination Effective Date

For services performed on or after 07/18/2008

Original Determination Ending Date

Revision Effective Date

For services performed on or after 01/01/2011

Revision Ending Date

Indications and Limitations of Coverage and/or Medical Necessity

Abstract:

A qualitative drug screen is used to detect the presence of a drug in the body. A blood or urine sample may be used. However, urine is the best specimen for broad qualitative screening, as blood is relatively insensitive for many common drugs, including psychotropic agents, opioids, and stimulants.

Common methods of drug analysis include chromatography, immunoassay, chemical ("spot") tests, and spectrometry. Analysis is comparative, matching the properties or behavior of a substance with that of a valid reference compound (a laboratory must possess a valid reference agent for every substance that it identifies). Drugs or classes of drugs are commonly assayed by qualitative screen, followed by confirmation with a second method.

Examples of drugs or classes of drugs that are commonly assayed by qualitative screens, followed by confirmation with a second method, are: alcohols, amphetamines, barbiturates/sedatives, benzodiazepines, cocaine and metabolites, methadone, antihistamines, stimulants, opioid analgesics, salicylates, cardiovascular drugs, antipsychotics, cyclic antidepressants, and others. Focused drug screens, most commonly for illicit drug use, may be more useful clinically. This local coverage determination documents National Government Services medical policy guidelines for the use of this laboratory test.

Indications:

"Although technology has provided the ability to measure many toxins, most toxicological diagnoses and therapeutic decisions are made based on historical or clinical considerations: (1) laboratory turnaround time can often be longer than the critical intervention time course of an overdose; (2) the cost and support of maintaining the instruments, staff training, and specialized labor involved in some analyses are prohibitive; (3) for many toxins there are no established cutoff levels of toxicity, making interpretation of the results difficult." "Although comprehensive screening is unlikely to affect emergency management, the results may assist the admitting physicians in evaluating the patient if the diagnosis remains unclear." Qualitative screening panels should be used when the results will alter patient management or disposition.(Richardson et al, 2007).

A qualitative drug screen may be indicated with a symptomatic patient when the history is unreliable, with a multiple-drug ingestion, with a patient in delirium or coma, for the identification of specific drugs, and to indicate when antagonists may be used. The clinical utility of drug screens in the emergency setting may be limited because patient management decisions are unaffected, since most therapy for drug poisonings is symptom directed and supportive.

Medicare will consider performance of a qualitative drug screen medically reasonable and necessary when a patient presents with suspected drug overdose and one or more of the following conditions:

A qualitative drug screen is medically reasonable and necessary for the monitoring of chronic pain patients in whom other illicit drug use is suspected.

Drugs or drug classes for which screening is performed should reflect only those likely to be present, based on the patient's medical history or current clinical presentation. Drugs for which specimens are being screened must be indicated by the referring provider in a written order.

Confirmation of drug screens (80102) is indicated when the result of the drug screen is different than that suggested by the patient's medical history, clinical presentation or patient’s own statement.

Limitations:

A qualitative drug screen is not medically reasonable or necessary to screen for the same drug with both a blood and a urine specimen simultaneously.

Medicare regards drug screening for medico-legal purposes (e.g., court-ordered drug screening) or for employment purposes (e.g., as a pre-requisite for employment or as a requirement for continuation of employment) as not medically necessary.

Other Comments:

For claims submitted to the fiscal intermediary or Part A MAC, this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated National Government Services to process their claims.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.

This LCD does not apply to acute inpatient (11x) claims.

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

012x	Hospital Inpatient (Medicare Part B only)
013x	Hospital Outpatient
014x	Hospital - Laboratory Services Provided to Non-patients
021x	Skilled Nursing - Inpatient (Including Medicare Part A)
022x	Skilled Nursing - Inpatient (Medicare Part B only)
023x	Skilled Nursing - Outpatient
071x	Clinic - Rural Health
072x	Clinic - Hospital Based or Independent Renal Dialysis Center
073x	Clinic - Freestanding
077x	Clinic - Federally Qualified Health Center (FQHC)
085x	Critical Access Hospital

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

0300	Laboratory - General Classification
0301	Laboratory - Chemistry
0309	Laboratory - Other Laboratory
0971	Professional Fees - Laboratory

CPT/HCPCS Codes

80100	DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES CHROMATOGRAPHIC METHOD, EACH PROCEDURE
80102	DRUG CONFIRMATION, EACH PROCEDURE
G0431	DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES BY HIGH COMPLEXITY TEST METHOD (E.G., IMMUNOASSAY, ENZYME ASSAY), PER PATIENT ENCOUNTER
G0434	DRUG SCREEN, OTHER THAN CHROMATOGRAPHIC; ANY NUMBER OF DRUG CLASSES, BY CLIA WAIVED TEST OR MODERATE COMPLEXITY TEST, PER PATIENT ENCOUNTER

ICD-9 Codes that Support Medical Necessity

It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

For monitoring of patient compliance in a drug treatment program, use ICD-9-CM code V71.09 as the primary diagnosis and the specific drug dependence diagnosis as the secondary diagnosis.

For the monitoring of patients on methadone maintenance and chronic pain patients with opioid dependence, suspected of abusing other illicit drugs, use code V 58.69.

276.2	ACIDOSIS
304.90	UNSPECIFIED DRUG DEPENDENCE UNSPECIFIED USE
305.90	OTHER MIXED OR UNSPECIFIED DRUG ABUSE UNSPECIFIED USE
345.10	GENERALIZED CONVULSIVE EPILEPSY WITHOUT INTRACTABLE EPILEPSY
345.11	GENERALIZED CONVULSIVE EPILEPSY WITH INTRACTABLE EPILEPSY
345.3	GRAND MAL STATUS EPILEPTIC
345.90	EPILEPSY UNSPECIFIED WITHOUT INTRACTABLE EPILEPSY
345.91	EPILEPSY UNSPECIFIED WITH INTRACTABLE EPILEPSY
426.10	ATRIOVENTRICULAR BLOCK UNSPECIFIED
426.11	FIRST DEGREE ATRIOVENTRICULAR BLOCK
426.12	MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK
426.13	OTHER SECOND DEGREE ATRIOVENTRICULAR BLOCK
426.82	LONG QT SYNDROME
427.0	PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA
427.1	PAROXYSMAL VENTRICULAR TACHYCARDIA
780.01	COMA
780.09	ALTERATION OF CONSCIOUSNESS OTHER
780.1	HALLUCINATIONS
780.39	OTHER CONVULSIONS
963.0	POISONING BY ANTIALLERGIC AND ANTIEMETIC DRUGS
965.00	POISONING BY OPIUM (ALKALOIDS) UNSPECIFIED
965.01	POISONING BY HEROIN
965.02	POISONING BY METHADONE
965.09	POISONING BY OTHER OPIATES AND RELATED NARCOTICS
965.1	POISONING BY SALICYLATES
965.4	POISONING BY AROMATIC ANALGESICS NOT ELSEWHERE CLASSIFIED
965.5	POISONING BY PYRAZOLE DERIVATIVES
965.61	POISONING BY PROPIONIC ACID DERIVATIVES
966.1	POISONING BY HYDANTOIN DERIVATIVES
967.0	POISONING BY BARBITURATES
967.1	POISONING BY CHLORAL HYDRATE GROUP
967.2	POISONING BY PARALDEHYDE
967.3	POISONING BY BROMINE COMPOUNDS
967.4	POISONING BY METHAQUALONE COMPOUNDS
967.5	POISONING BY GLUTETHIMIDE GROUP
967.6	POISONING BY MIXED SEDATIVES NOT ELSEWHERE CLASSIFIED
967.8	POISONING BY OTHER SEDATIVES AND HYPNOTICS
967.9	POISONING BY UNSPECIFIED SEDATIVE OR HYPNOTIC
969.00	POISONING BY ANTIDEPRESSANT, UNSPECIFIED
969.01	POISONING BY MONOAMINE OXIDASE INHIBITORS
969.02	POISONING BY SELECTIVE SEROTONIN AND NOREPINEPHRINE REUPTAKE INHIBITORS
969.03	POISONING BY SELECTIVE SEROTONIN REUPTAKE INHIBITORS
969.04	POISONING BY TETRACYCLIC ANTIDEPRESSANTS
969.05	POISONING BY TRICYCLIC ANTIDEPRESSANTS
969.09	POISONING BY OTHER ANTIDEPRESSANTS
969.1	POISONING BY PHENOTHIAZINE-BASED TRANQUILIZERS
969.2	POISONING BY BUTYROPHENONE-BASED TRANQUILIZERS
969.3	POISONING BY OTHER ANTIPSYCHOTICS NEUROLEPTICS AND MAJOR TRANQUILIZERS
969.4	POISONING BY BENZODIAZEPINE-BASED TRANQUILIZERS
969.5	POISONING BY OTHER TRANQUILIZERS
969.6	POISONING BY PSYCHODYSLEPTICS (HALLUCINOGENS)
969.70	POISONING BY PSYCHOSTIMULANT, UNSPECIFIED
969.71	POISONING BY CAFFEINE
969.72	POISONING BY AMPHETAMINES
969.73	POISONING BY METHYLPHENIDATE
969.79	POISONING BY OTHER PSYCHOSTIMULANTS
969.8	POISONING BY OTHER SPECIFIED PSYCHOTROPIC AGENTS
969.9	POISONING BY UNSPECIFIED PSYCHOTROPIC AGENT
970.81	POISONING BY COCAINE
970.89	POISONING BY OTHER CENTRAL NERVOUS SYSTEM STIMULANTS
972.1	POISONING BY CARDIOTONIC GLYCOSIDES AND DRUGS OF SIMILAR ACTION
977.9	POISONING BY UNSPECIFIED DRUG OR MEDICINAL SUBSTANCE
V58.69	LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS
V71.09	OBSERVATION OF OTHER SUSPECTED MENTAL CONDITION

Diagnoses that Support Medical Necessity

Not applicable

ICD-9 Codes that DO NOT Support Medical Necessity

Not applicable

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity

Not applicable

General Information

Documentation Requirements

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Medical record documentation (e.g., history and physical, progress notes) maintained by the ordering physician/referring physician must indicate the medical necessity for performing a qualitative drug screen. All tests must be ordered in writing by a treating provider and all drugs/drug classes to be screened must be indicated in the order. When the qualitative drug screen is performed for monitoring purposes for patients receiving active treatment for substance abuse, the medical record should reflect the specific need for the tests as part of the plan of care for the patient. Additionally, a copy of the lab results should be maintained in the medical records.

If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of the lab results, along with copies of the ordering/referring physician’s order for the qualitative drug screen. The physician must state the clinical indication/medical necessity for the qualitative drug screen in the order for the test.

Appendices

Not applicable

Utilization Guidelines

It is expected that these services would be performed as indicated by current medical literature and/or standards of practice. When services are performed in excess of established parameters, they may be subject to review for medical necessity.

Sources of Information and Basis for Decision

This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

D'Onofrio GD, Becker B, Woolard RH. Emerg Med Clin N Am. 2006;24:925-967.

Eldridge DL, Holstege CP. Emerg Med Clin N Am. 2006;26:13-30.

Erickson TB, Thompson TM. The approach to the patient with an unknown overdose. Emerg Med Clin N Am. 2007;25:249-281.

Ford M, Delaney KA, Ling L, Erickson T. Clinical Toxicology. 1st ed (2001) WB Saunders, Chapter 7.

Kreismann EK, Gang M, Goldfrank LR. Emerg Med Clin N Am. 2006;24:769-784.

Haroz R, Greenberg MI. Clin Lab Med. 2006;26:147-164.

Holstege CP, Dobmeier SG, Bechtel LK. Emerg Med Clin N Am. 2008;25:715-739.

Myrick H, Cluver J, Swavely S, Peters H. Diagnosis and treatment of co-occurring affective disorders and substance use disorders. Psychiatric Clinics of North America. 2004;24(4):649-659.

Perrone J, Roos F, Jayaraman S, et al. Drug screening versus history in detection of substance use in ED psychiatric patients. American Journal of Emergency Medicine. 2001;19:49-1951.

Principles of drug addiction treatment: A research-based guide.
US Department of Health and Human Services, National Institute of Drug Abuse. 1999. Available at: http://drugabuse.gov/podat/podat1.html. Accessed October 18, 2002.

Richardson WH, Slone CM, Michels JE. Emerg Med Clin N Am. 2007;25:435-457.

Advisory Committee Meeting Notes

Carrier Advisory Committee Meeting Date(s):

Connecticut: 01/27/2009
Indiana: 01/26/2009
Kentucky: 01/22/2009
New York: 01/28/2009

This coverage determination does not reflect the sole opinion of the contractor or contractor Medical Director. Although the final decision rests with the contractor, this determination is developed in consultation with representatives from Advisory Committee members and/or from various state and local provider organizations.

Start Date of Comment Period

01/08/2009

End Date of Comment Period

02/21/2009

Start Date of Notice Period

01/01/2011

Revision History Number

Revision History Explanation

R7 (effective 01/01/2011): Revised for annual 2011 CPT code update. CPT code G0430 was deleted and replaced with CPT code G0434. Descriptors were changed for CPT code 80100 and HCPCS code G0431. ICD-9 code 305.90 was added to the ICD-9 Codes that Support Medical Necessity. Minor changes made to update for NGS and CMS template changes. No notice given and none required.

R6 (effective 10/01/2010): LCD revised for annual ICD-9-CM code updates for 2011. ICD-9 code 970.8 was deleted and replaced with 970.81 and 970.89 for CPT/HCPCS codes 80100, 80102, G0430, and G0431. Minor changes were made to reflect current template language. No comment period required and none given.

R5 (effective 06/01/2010): Removed CMS National Policy citation added to policy in error. No notice and comment required and none given.

R4 (effective 05/01/2010): Effective April 1, 2010, CPT Code 80101 will no longer be covered by Medicare and was removed from this policy. Although the revision effective date for this code update is May 1, 2010, CPT code 80101 will no longer be valid for claims submitted on, or after 04/01/2010. CMS National Policy citations were updated. No notice required and none given. This SIA associated with this LCD was similarly updated.

R3 (effective 01/01/2010): Source of Revision 2010 CPT/HCPCS Code Updates - New HCPCS codes G0430 and G0431 were added to the policy. Based on CR 6338, Change Type of Bill (TOB) for Federally Qualified Health Centers (FQHCs) from 73x to 77x, the following paragraph has been added to the “Other Comments” section of the LCD: “For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.” Minor changes were made to reflect current template language. No comment period required and none given. The SIA associated with this policy was similarly updated.

R2 (effective 10/01/2009): Source of Revision – Annual ICD-9-CM code updates.

ICD-9 code 969.0 was deleted and replaced with codes 969.00, 969.01, 969.02, 969.03, 969.04, 969.05, and 969.09. ICD-9 code 969.7 was deleted and replaced with codes 969.70, 969.71, 969.72, 969.73, and 969.79.

Indications were updated as follows: The bullet “For the monitoring of chronic pain patients with iatrogenic opioid dependence in whom other illicit drug use is suspected.” was removed. “A qualitative drug screen is medically reasonable and necessary for the monitoring of chronic pain patients in whom other illicit drug use is suspected.” was added.

References were updated for current template and other minor typographical changes were made to the policy. The Supplemental Instructions Article associated with this policy was not revised.

(R1) (Effective 07/01/2009):Source of revision – Internal. The existing LCD was resubmitted to all NGS Part A and Part B jurisdictions for public and CAC comment from 01/08/2009 through 02/21/2009. ICD-9-CM code 345.3 replaced codes 345.30 and 345.31. In addition to the J13 MAC contracts for which it was already in effect, this policy now applies to all NGS contracts listed under Primary Geographic Jurisdiction.

An interim article was published in May, 2009 that temporarily expanded the list of payable ICD-9 codes to include codes 304.00-304.93 and 305.00-305.93, effective for dates of service from the original J-13 LCD effective dates, listed below, through June 30, 2009 for J-13 states (NY and CT) only.

This LCD is effective for Downstate New York – Part B on July 18, 2008; for Connecticut – Part B on August 1, 2008; for Upstate New York – Part B on September 1, 2008; for New York and Connecticut – Part A on November 14, 2008.

The CMS Statement of Work for the J13 Medicare Administrative Contract (MAC) requires that the contractor retain the most clinically appropriate LCD within the jurisdiction. This First Coast Service Options policy is being promulgated to the J13 MAC as the most clinically appropriate LCD within that jurisdiction.

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The following are administrative notes entered by the Medicare Coverage Database Contractor:

08/08/2009 - This policy was updated by the ICD-9 2009-2010 Annual Update.

3/7/2010 - The description for Bill Type Code 73 was changed
3/7/2010 - The description for Bill Type Code 77 was changed

8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 14 was changed
8/1/2010 - The description for Bill Type Code 21 was changed
8/1/2010 - The description for Bill Type Code 22 was changed
8/1/2010 - The description for Bill Type Code 23 was changed
8/1/2010 - The description for Bill Type Code 71 was changed
8/1/2010 - The description for Bill Type Code 72 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed

8/1/2010 - The description for Revenue code 0300 was changed
8/1/2010 - The description for Revenue code 0301 was changed
8/1/2010 - The description for Revenue code 0309 was changed
8/1/2010 - The description for Revenue code 0971 was changed

09/06/2010 - This policy was updated by the ICD-9 2010-2011 Annual Update.

11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
80100 descriptor was changed in Group 1
G0431 descriptor was changed in Group 1

11/21/2010 - The following CPT/HCPCS codes were deleted:
G0430 was deleted from Group 1

Reason for Change

HCPCS Addition/Deletion
ICD9 Addition/Deletion

Last Reviewed On Date

01/01/2011