April Update Affects Coverage for 23 Lab NCDs

April Update Affects Coverage for 23 Lab NCDs

Twenty-three National Coverage Determinations (NCDs) for clinical diagnostic laboratory services have been updated to reflect the April 2018 quarterly release of the edit module for such services. ICD-10-CM codes in effect April 1 affect coverage for several common lab tests.

Note ICD-10-CM Code Changes in Lab NCDs

The following lab NCDs add/delete ICD-10-CM codes from the list of covered/denied diagnoses:

190.12 Urine Culture, Bacterial

190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)

190.14 Human Immunodeficiency Virus (HIV) Testing Diagnosis

190.15 Blood Counts

190.16 Partial Thromboplastin Time (PTT)

190.17 Prothrombin Time (PT)

190.18 Serum Iron Studies

190.19 Collagen Crosslinks, Any Method

190.20A Blood Glucose Testing

190.20B Blood Glucose Testing

190.21 Glycated Hemoglobin/Glycated Protein

190.22 Thyroid Testing

190.23A Lipids Testing

190.23B Lipids Testing

190.25 Alpha-fetoprotein

190.26 Carcinoembryonic Antigen

190.28 Tumor Antigen by Immunoassay CA 125

190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29

190.30 Tumor Antigen by Immunoassay CA 19-9

190.31 Prostate Specific Antigen

190.32 Gamma Glutamyl Transferase

190.33 Hepatitis Panel/Acute Hepatitis Panel

190.34 Fecal Occult Blood Test

Non-covered ICD-10-CM Codes for All Lab NCDs

With the Oct. 1, 2017, update to the ICD-10-CM code set, several codes were added to Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00-Z99).

Specifically, codes Z36.0-Z36.9 were added “to account for encounters for antenatal screening for various issues (e.g., Z36.4 Encounter for antenatal screening for fetal growth retardation),” reported Amy C. Pritchett, BSHA, CPC, CPMA, CPC-I, CANPC, CASCC, CEDC, CRC, CDEO, CCS, ICDCT-CM/PCS, C-AHI, in the article “Look Ahead at ICD-10-CM in 2018” (Healthcare Business Monthly, December 2017). “There are also some note changes, so review this chapter carefully.”

ICD-10-CM Codes

Z36.0 Encounter for antenatal screening for chromosomal anomalies
Z36.1 Encounter for antenatal screening for raised alphafetoprotein level
Z36.2 Encounter for other antenatal screening follow-up
Z36.3 Encounter for antenatal screening for malformations
Z36.4 Encounter for antenatal screening for fetal growth retardation
Z36.5 Encounter for antenatal screening for isoimmunization
Z36.81 Encounter for antenatal screening for hydrops fetalis
Z36.82 Encounter for antenatal screening for nuchal translucency
Z36.83 Encounter for fetal screening for congenital cardiac abnormalities
Z36.84 Encounter for antenatal screening for fetal lung maturity
Z36.85 Encounter for antenatal screening for Streptococcus B
Z36.86 Encounter for antenatal screening for cervical length
Z36.87 Encounter for antenatal screening for uncertain dates
Z36.88 Encounter for antenatal screening for fetal macrosomia
Z36.89 Encounter for other specified antenatal screening
Z36.8A Encounter for antenatal screening for other genetic defects
Z36.9 Encounter for antenatal screening, unspecified

These codes are never covered by Medicare for a diagnostic lab testing service. If a code from this section is given as the reason for the test, the test may be billed to the Medicare beneficiary without billing Medicare first because the service is not covered by statute, in most instances because it is performed for screening purposes and is not within an exception. The beneficiary, however, does have a right to have the claim submitted to Medicare, upon request.

Update Your Code Lists

The Centers for Medicare & Medicaid Services (CMS) Change Request 10424 adds to the list of ICD-10-CM codes that are covered/noncovered for the following NCDs, effective April 1, 2018.

Note: The codes listed below are just those added for the April 2018 update. See the NCD for the complete list of covered/non-covered codes.

NCD 190.15

Non-covered:

T07.XXXA Unspecified multiple injuries, initial encounter
T07.XXXS Unspecified multiple injuries, sequela
T14.8XXS Other injury of unspecified body region, sequela
T14.90XA Injury, unspecified, initial encounter
T14.90XS Injury, unspecified, sequela
NCD 190.16

Covered:

E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction
NCD 190.17

Covered:

D47.09 Other mast cell neoplasms of uncertain behavior
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction
K91.30 Postprocedural intestinal obstruction, unspecified as to partial versus complete
K91.31 Postprocedural partial intestinal obstruction
K91.32 Postprocedural complete intestinal obstruction
T14.8XXA Other injury of unspecified body region, initial encounter
T14.90XA Injury, unspecified, initial encounter
NCD 190.18

Covered:

A04.71 Enterocolitis due to Clostridium difficile, recurrent
A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent
D47.09 Other mast cell neoplasms of uncertain behavior
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction
NCD 190.23

Covered:

E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
NCD 190.32

Covered:

D47.09 Other mast cell neoplasms of uncertain behavior
E85.82 Wild-type transthyretin-related (ATTR) amyloidosis
E85.89 Other amyloidosis
F13.11 Sedative, hypnotic or anxiolytic abuse, in remission
F16.11 Hallucinogen abuse, in remission
F18.11 Inhalant abuse, in remission
F19.11 Other psychoactive substance abuse, in remission
K56.50 Intestinal adhesions [bands], unspecified as to partial versus complete obstruction
K56.51 Intestinal adhesions [bands], with partial obstruction
K56.52 Intestinal adhesions [bands] with complete obstruction
K56.600 Partial intestinal obstruction, unspecified as to cause
K56.601 Complete intestinal obstruction, unspecified as to cause
K56.609 Unspecified intestinal obstruction, unspecified as to partial versus complete obstruction
K56.690 Other partial intestinal obstruction
K56.691 Other complete intestinal obstruction
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction
NCD 190.34

Covered:

A04.71 Enterocolitis due to Clostridium difficile, recurrent
A04.72 Enterocolitis due to Clostridium difficile, not specified as recurrent
K56.699 Other intestinal obstruction unspecified as to partial versus complete obstruction

Know When to Code Diagnoses vs. Signs and Symptoms

On and after the implementation date for ICD-10-CM coding of Medicare billing claims, a claim for a clinical diagnostic laboratory service must include a valid ICD-10-CM diagnosis code. When a diagnosis has not been established by the physician, codes that describe symptoms and signs, as opposed to diagnoses, should be provided.


Source:

April 2018 ICD-10-CM quarterly update to Lab NCDs

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

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