Two Laboratory NCDs Get Last Minute Code Changes

One month after the October update for Medicare’s edit module for clinical diagnostic laboratory national coverage determinations (NCDs), the Centers for Medicare & Medicaid Services (CMS) announced, Nov. 4, that further changes will be included in the January 2012 release of the laboratory edit module.

According to CMS transmittal 2344 (which replaces rescinded transmittal 2320, issued Oct. 21), effective Jan. 1, 2012, the following diagnosis codes will be deleted from the list of ICD-9-CM codes that are covered by Medicare for the Alpha-fetoprotein (190.25) NCD:

425.11  Hypertrophic obstructive cardiomyopathy

425.18  Other hypertrophic cardiomyopathy

Effective Oct. 1, 2011, CMS is adding to the list of ICD-9-CM codes that are covered by Medicare for the Prothrombin Time (PT) (190.17) NCD. The two codes are:

786.50  Chest pain, unspecified

786.51 Precordial pain

To ensure these edits are properly updated during the ICD-10 implementation, contractors will track the ICD-10 counterparts for these two codes. ICD-9 codes 786.50 and 786.51 crosswalk to:

R07.9  Chest pain, unspecified

R07.2  Precordial pain

Contractors will not search their files to either retract payment for claims already paid or to retroactively pay claims, but will adjust claims brought to their attention.


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