CMS Revises Clinical Diagnostic Lab NCD

Centers for Medicare & Medicaid Services (CMS) Transmittal 1766, Change Request 6548, issued July 10, announces the changes that will be included in the October 2009 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs).

The changes to code lists that are effective for dates of service on and after Oct. 1 are as follows:

For the Urine Culture, Bacterial:

  • Add ICD-9-CM codes 670.10, 670.12, 670.14, 670.20, 670.22, 670.24, 670.30, 670.32, 670.34, 670.80, 670.82, 670.84, and 789.7 to the list of ICD-9-CM codes covered by Medicare for the Urine Culture, Bacterial (190.12) NCD.

For Blood Counts:

  • Add ICD-9-CM codes V26.42, V26.82, V53.50-V53.51, V53.59, V61.07-V61.08, V61.23-V61.25, V61.42, V72.60-V72.63, and V72.69 to the list of ICD-9-CM codes that Do Not Support Medical Necessity for the Blood Counts (190.15) NCD.
  • Delete ICD-9-CM codes V53.5 and V72.6 from that list.

For Partial Thromboplastin Time (PTT):

  • Add ICD-9-CM codes 453.50-453.52, 453.6, 453.71-453.77, 453.79, 453.81-453.87, 453.89, 789.7, and 995.24 to the list of ICD-9-CM codes covered by Medicare for the PTT (190.16) NCD.
  • Delete ICD-9-CM code 453.8 from that list.

For Prothrombin Time (PT):

  • Add ICD-9-CM codes 209.70-209.75, 209.79, 453.50-453.52, 453.6, 453.71-453.77, 453.79, 453.81-453.87, 453.89, 789.7, and 995.24 to the list of ICD-9-CM codes covered by Medicare for the PT (190.17) NCD.
  • Delete ICD-9-CM code 453.8 from that list.
  • Replace the duplicate ICD-9-CM code 868.19 with 868.09 within that list.

For Serum Iron Studies:

  • Add ICD-9-CM codes 209.31-209.36, 209.70-209.75, 209.79, 239.81, 239.89, 285.3, 453.50-453.52 and 569.87 to the list of ICD-9-CM codes covered by Medicare for the Serum Iron Studies (190.18) NCD.
  • Delete ICD-9-CM code 239.8 from the list of ICD-9-CM codes covered by Medicare for the Serum Iron Studies (190.18) NCD.

For Thyroid Testing:

  • Add ICD-9-CM codes 279.41, 279.49, 784.42-784.44, 784.51, 784.59, 799.21-799.25, 799.29, and V10.91 to the list of ICD-9-CM codes covered by Medicare for the Thyroid Testing (190.22) NCD.
  • Delete ICD-9-CM codes 279.4, 784.5, and 799.2 from that list.

For Lipids Testing:

  • Add ICD-9-CM codes 438.13-438.14 to the list of ICD-9-CM codes covered by Medicare for the Lipids Testing (190.23) NCD.

For Digoxin Therapeutic Drug Assay:

  • Add ICD-9-CM codes 787.04, 799.21-799.25, 799.29 and 995.24 to the list of ICD-9-CM codes covered by Medicare for the Digoxin Therapeutic Drug Assay (190.24) NCD.
  • Delete ICD-9-CM code 799.2 from that list.

For Alphafetoprotein:

  • Add ICD-9-CM codes 209.70-209.75 and 209.79 to the list of ICD-9-CM codes covered by Medicare for the Alpha-fetoprotein (190.25) NCD.

For Carcinoembryonic Antigen:

  • Add ICD-9-CM codes 209.70-209.75 and 209.79 to the list of ICD-9-CM codes covered by Medicare for the Carcinoembryonic Antigen (190.26) NCD.

For Gamma Glutamyl Transferase:

  • Add ICD-9-CM codes 209.70-209.75, 209.79, 453.6, 453.71-453.77, 453.79, 453.81-453.87, 453.89, 569.87, 969.00-969.05, 969.09, 969.70-969.73 and 969.79 to the list of ICD-9-CM codes covered by Medicare for the Gamma Glutamyl Transferase (190.32) NCD.
  • Delete ICD-9-CM codes 453.8, 969.0 and 969.7 from that list.

For the Hepatitis Panel/Acute Hepatitis Panel:

  • Add ICD-9-CM codes 787.04 and 789.7 to the list of ICD-9-CM codes covered by Medicare for the Hepatitis Panel/Acute Hepatitis Panel (190.33) NCD.

For Fecal Occult Blood Test:

  • Add ICD-9-CM codes 209.70-209.75, 209.79, 285.3, 569.87, 787.04, 789.7 and 995.24 to the list of ICD-9-CM codes covered by Medicare for the Fecal Occult Blood Test (190.34) NCD.
  • Delete CPT® code G0394 from the list of CPT® codes covered by Medicare for the Fecal Occult Blood Test (190.34) NCD.

For all 23 Lab NCDs:

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  • ICD-9-CM codes V20.31-V20.32, V60.81. V60.89, V80.01, and V80.09 will be denied for all 23 NCDs.
  • ICD-9-CM codes V60.8 and V80.0 will be deleted from the non-covered by Medicare lists for all 23 NCDs.

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