One month after the October update for Medicare’s edit module for clinical diagnostic laboratory national coverage determinations (NCDs), the Centers for Medicare & Medicaid Services (CMS) announced, Nov. 4, that further changes will be included in the January 2012 release of the laboratory edit module.
According to CMS transmittal 2344 (which replaces rescinded transmittal 2320, issued Oct. 21), effective Jan. 1, 2012, the following diagnosis codes will be deleted from the list of ICD-9-CM codes that are covered by Medicare for the Alpha-fetoprotein (190.25) NCD:
425.11 Hypertrophic obstructive cardiomyopathy
425.18 Other hypertrophic cardiomyopathy
Effective Oct. 1, 2011, CMS is adding to the list of ICD-9-CM codes that are covered by Medicare for the Prothrombin Time (PT) (190.17) NCD. The two codes are:
786.50 Chest pain, unspecified
786.51 Precordial pain
To ensure these edits are properly updated during the ICD-10 implementation, contractors will track the ICD-10 counterparts for these two codes. ICD-9 codes 786.50 and 786.51 crosswalk to:
R07.9 Chest pain, unspecified
R07.2 Precordial pain
Contractors will not search their files to either retract payment for claims already paid or to retroactively pay claims, but will adjust claims brought to their attention.
November 14th, 2011
The Centers for Medicare & Medicaid Services (CMS) recently informed Medicare payers in Change Request (CR 6964) of changes that will be included in the July 2010 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs).
The following changes affect physicians, providers and suppliers submitting claims to Medicare for clinical diagnostic laboratory services:
- ICD-9-CM codes V17.4 Family history of other cardiovascular diseases and V18.1 Family history of other endocrine and metabolic diseases have been deleted from the list of non-covered ICD-9-CM codes for all 23 NCDs; and
- ICD-9-CM codes V17.41 Family history of sudden cardiac death (SCD), V17.49 Family history of other cardiovascular diseases, V18.11 Family history of multiple endocrine neoplasia [MEN] syndrome, and V18.19 Family history of other endocrine and metabolic diseases have been added to the list of non-covered ICD-9-CM codes for all 23 NCDs.
These changes to the laboratory edit module are effective for service dates on or after July 1.
Provider education article MLN Matters MM6964 is also available on the CMS website.
May 14th, 2010