CMS Updates Clinical Lab NCDs for October

Physicians, providers, and suppliers should note the Centers for Medicare & Medicaid Services’ (CMS’s) recent coding policy changes to several clinical diagnostic laboratory services’ national coverage determinations (NCD). Check for similar updates to local coverage determinations (LCD). Recent national-level changes are described in the Medicare NCD Coding Policy Manual and Change Report for October 2010.

NCD manual updates for Oct. 1 include:

Urine Culture, Bacterial NCD (190.12)
Add ICD-9-CM code 780.66 Febrile nonhemolytic transfusion reaction to the list of covered codes.

Human Immunodeficiency Virus (HIV) Testing (Diagnosis) NCD (190.14)
Add ICD-9-CM codes 780.66, 786.30 Hemoptysis, unspecified, 786.31 Acute idiopathic pulmonary hemorrhage in infants (AIPHI), and 786.39 Other hemoptysis to the list of covered codes.

Delete ICD-9-CM code 786.3 Hemoptysis from the list of covered codes.

Blood Counts NCD (190.15)
Add ICD-9-CM codes 832.2 Nursemaid’s elbow, V11.4 Personal history of combat and operational stress reaction, V25.11 Encounter for insertion of intrauterine contraceptive device, V25.12 Encounter for removal of intrauterine contraceptive device, V25.13 Encounter for removal and reinsertion of intrauterine contraceptive device, V49.86 Do not resuscitate status, and V62.85 Homicidal ideation to the list of Do Not Support Medical Necessity codes.

Delete ICD-9-CM code V25.1 Encounter for insertion of intrauterine contraceptive device from the list of Do Not Support Medical Necessity codes.

Partial Thromboplastin Time (PTT) NCD (190.16)
Add ICD-9-CM codes 275.01 Hereditary hemochromatosis, 275.02 Hemochromatosis due to repeated red blood cell transfusions, 275.03 Other hemochromatosis, 275.09 Other disorders of iron metabolism, 287.41 Posttransfusion purpura, 287.49 Other secondary thrombocytopenia, 786.30, 786.31, and 786.39 to the list of covered codes.

Delete ICD-9-CM codes 275.0 Disorders of iron metabolism, 287.4 Secondary thrombocytopenia, and 786.3 from the list of codes covered.

Prothrombin Time NCD (190.17)
Add ICD-9-CM codes 275.01, 275.02, 275.03, 275.09, 287.41, 287.49, 786.30, 786.31, 786.39, 999.80 Transfusion reaction, unspecified, 999.83 Hemolytic transfusion reaction, incompatibility unspecified, 999.84 Acute hemolytic transfusion reaction, incompatibility unspecified, and 999.85 Delayed hemolytic transfusion reaction, incompatibility unspecified to the list of covered codes.

Delete ICD-9-CM codes 275.0, 287.4, and 786.3 from the list of covered ICD-9-CM codes.

Serum Iron Studies NCD (190.18)
Add ICD-9-CM codes 237.73 Schwannomatosis, 237.79 Other neurofibromatosis, 275.01, 275.02, 275.03, 275.09, 287.41, 287.49, 999.80, 999.83, 999.84, and 999.85 to the list of covered codes.

Delete ICD-9-CM codes 275.0 and 287.4 from the list of covered ICD-9-CM codes.

Blood Glucose Testing NCD (190.20)
Add ICD-9-CM codes 275.01, 275.02, 275.03, 275.09, 276.61 Transfusion associated circulatory overload, 276.69 Other fluid overload, 780.33 Post traumatic seizures, 787.60 Full incontinence of feces, 787.61 Incomplete defecation, 787.62 Fecal smearing, and 787.63 Fecal urgency to the list of covered codes.

Delete ICD-9-CM codes 275.0, 276.6 Fluid overload, and 787.6 Incontinence of feces from the list of covered codes.

Glycated Hemoglobin/ Glycated Protein NCD (190.21)
Add ICD-9-CM codes 275.01, 275.02 Hemochromatosis due to repeated red blood cell transfusions, 275.03, and 275.09 to the list of covered ICD-9-CM codes.

Delete ICD-9-CM code 275.0 from the list of covered codes.

Lipids Testing NCD (190.23)
Add ICD-9-CM code 278.03 Obesity hypoventilation syndrome to the list of covered ICD-9-CM codes.

Digoxin Therapeutic Drug Assay NCD (190.24)
Add ICD-9-CM codes 276.61 and 276.69 to the list of covered ICD-9-CM codes.

Delete ICD-9-CM code 276.6 from the list of covered ICD-9-CM codes.

Alpha-fetoprotein NCD (190.25)
Add ICD-9-CM codes 275.01, 275.02, 275.03, and 275.09 to the list of covered codes.

Delete ICD-9-CM code 275.0 from the list of codes.

Gamma Glutamyl Transferase NCD (190.32)
Add ICD-9-CM codes 237.73, 237.79, 275.01, 275.02, 275.03, 275.09, 560.32 Fecal impaction, 780.66, 970.81 Poisoning by cocaine, and 970.89 Poisoning by other central nervous system stimulants to the list of covered codes.

Delete ICD-9-CM codes 275.0 and 970.8 Poisoning by other specified central nervous system stimulants from the list of covered codes.

Hepatitis Panel/Acute Hepatitis Panel NCD (190.33)
Add ICD-9-CM code 780.33 to the list of covered codes.

Fecal Occult Blood Test NCD (190.34)
Add ICD-9-CM codes 287.41, 287.49, and 560.32 to the list of covered codes.

Delete ICD-9-CM code 287.4 from the list of covered codes.

The official instruction, CR 7057, issued to your Medicare carrier, fiscial intermediary (FI), or Parts A/B Medicare administractive contractor (A/B MAC) regarding these NCD policy changes may be viewed the CMS website.

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