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

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:

NCD 190.16

Covered:

NCD 190.17

Covered:

NCD 190.18

Covered:

NCD 190.23

Covered:

NCD 190.32

Covered:

NCD 190.34

Covered:

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

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Renee Dustman

Managing Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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