Take Notice: Lab NCD Edit Changes in Quarterly Update

The Centers for Medicare & Medicaid Services (CMS) has made a few important changes to the National Coverage Determination (NCD) edit software for clinical diagnostic laboratory services worth noting. In particular, a change to the effective date of coverage for three NCD ICD-9-CM diagnosis code lists will allow clinics to recoup any lost payments due to erroneous denials.

The effective date for three NCDs was “inadvertently” changed from Oct. 1, 2007 to July 1, 2009 with the July 1 quarterly release. The January 2010 quarterly release of the edit module for clinical diagnostic laboratory services corrects this mistake.

The affected ICD-9 code lists are those in the following NCDs:

  • Prothrombin Time (PT) (190.17)
  • Serum Iron Studies (190.18)
  • Gamma Glutamyl Transferase (190.32)

The effective date for the ICD-9 codes listed in these NCDs will be revised from July 1, 2009 to Oct. 1, 2007, effective Jan. 1, 2010.

The January 2010 quarterly update also relocates ICD-9 codes 453-50 – 453.52 from the Serum Iron Studies NCD to the Gamma Glutamyl Transferase NCD, effective Jan. 1, 2010.

Medicare instructs contractors in Transmittal 1847, issued Nov. 6, not to search their files to retroactively pay claims but to adjust claims brought to their attention. A provider education article is available on the CMS Web site, and includes a list of affected ICD-9 codes.

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