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Check NCDs for Medical Necessity Code Changes

Check NCDs for Medical Necessity Code Changes

When ICD-10-CM is updated Oct. 1, so are these National Coverage Determinations.

Are you wondering which National Coverage Determinations (NCDs) will be affected by the thousands of diagnosis code changes going into effect Oct. 1? A Centers for Medicare & Medicaid Services (CMS) transmittal tells all.

CMS Transmittal 11546, issued Aug. 4, is a one-time notification to Medicare Administrative Contractors shared-system maintainers for ICD-10-CM conversions and other coding updates to NCDs.

Check to see if any services your office or facility provide, for which there is an NCD, is affected by the ICD-10-CM code set update for fiscal year (FY) 2023.

NCDs Affected by ICD-10-CM Update

The following NCDs are being updated to include, as applicable, code changes in the FY 2023 ICD-10-CM code set update. Changes are effective Oct. 1, 2022.

  • NCD 110.18 Aprepitant
  • NCD 110.23 Stem Cell Transplants
  • NCD 150.3 Bone Density Studies
  • NCD 160.18 Vagus Nerve Stimulation (VNS)
  • NCD 190.3 Cytogenetic Studies
  • NCD 210.6 Screening for Hepatitis B Vaccine
  • NCD 220.6.17 PET for Solid Tumors
  • NCD 220.6.20 PET Beta Amyloid for Dementia/Neurodegenerative Disease
  • NCD 260.5 Intestinal/Multi-Visceral Transplants
  • NCD 260.9 Heart Transplants

The NCD for cytogenetic studies adds several new codes born from existing code O35.1 Maternal care for (suspected) chromosomal abnormality in fetus (O35.10X0-O35.19X9). And the NCD for amyloid for dementia/neurodegenerative disease adds new codes that were created to allow for more specific reporting of dementia (F01.511-F03.C4).

Reference the CMS transmittal for the complete list of code additions, deletions, and revisions.

See also MLN Matters 12822 for more NCDs being updated.

Call to Action

Although these code additions do not indicate a change to Medicare policy for these NCDs, it is essential to begin using the more specific codes when documentation supports their use. If documentation doesn’t support the added specificity, consider educating providers on the new ICD-10-CM documentation requirements for capturing these new codes for FY 2023.

Renee Dustman
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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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