CCI

Changes to Correct Coding Edits, Version 9.2

Effective July 1, 2003, Medicare will implement the quarterly Correct Coding Initiative (CCI) Edits.

New Blood Count Conflicts have been added:

The following codes were added as mutually exclusive procedures:

The following codes were modified as mutually exclusive procedures:

An extensive list of mutually exclusive surgical pathology (biopsy) codes have been added.

CCI Edits are available through National Technical Information Service, (NTIS)

Medicare Adds Diagnosis Codes for Screening Pap Smear

On May 22, 2003 two new diagnosis codes for low risk (V76.47 and V76.49. V76.49) have been added for providers to use for women without a cervix.

The following chart list the diagnosis codes that are payable for low risk or high risk patients for pap smear.

NDC

New Lab NCD Coding Release On CMS Website

The Centers for Medicare and Medicaid Services has posted on its Website the July 2003 release of its coding manual for laboratory NCDs, or National Coverage Determinations. The release:

• Corrects an error in the ICD-9-CM diagnosis code given for pneumocystosis (changed to read 136.3). This affects HIV-1 test diagnosis codes
• Adds new CPT codes for blood counts
• Corrects osteomyelitis of the ankle & foot codes under the blood glucose NCD

Go to Coding Release for details.

July Release

The July release of NCDs is now available. The update includes the correction of a typo 136.2 changed to 136.3 in the Human Immunodeficiency Virus Testing (Diagnosis) Edit 3. It also has the new CPT additions for Blood Counts Edit 4. The additions are 85004,85032 and 85049. For Edit 9 Blood Glucose Testing the ICD-9-CM code ranges 730.08-730.09; 730.10-730.16;730.18-730.19 and 730.20-730.26 are terminated as of 07/01/03. The ranges are replaced by 730.07,730.17 and 730.27.

Go to Lab Index List for details.

CMS

Prothrombin Time and Fecal Occult Blood

(Revision of ICD-9-CM Codes for Injury to Gastrointestinal Tract)

Issue: The current national coverage determination (NCD) for Prothrombin Time (PT) and Fecal Occult Blood Tests (FOBT) includes ICD-9-CM codes 863.0-863.90, injury to gastrointestinal tract, in the list of covered diagnoses. CMS is considering adding the remaining codes in the 863.90-863.99 series. The following codes may also be added to the list of covered diagnoses for PT and FOBT: 863.91, open wound, pancreas head; 863.92, open wound, pancreas body; 863.93, open wound, pancreas tail; 863.94 open wound, pancreas, multiple and unspecified sites; 863.95 open wound, appendix; and 863.99 open wound, other gastrointestinal sites.

Expected Completion Date for Review of NCD Request: 9/1/2003

Go to CAG-00187N for details.

Lipid Testing

(Clarification of ICD-9-CM Codes for Hypertension)

Revised tracking sheet correcting the benefit category designation.

Issue: In the preamble to the November 23, 2001 final rule on clinical diagnostic laboratory services, CMS stated at 66 FR 58796 and 58806 they would be altering the proposed lipid policy to include code range 401.0-401.9 in the list of covered diagnoses for lipid testing. Unfortunately, the published NCD at 66 FR 58859 used a comma in lieu of a dash resulting in codes 401.0 and 401.9 being included in the list of covered diagnoses, but failing to cover the intervening code, 401.1. CMS intends to correct the NCD to include the entire code range 401.1-401.9 as explained in the preamble to the final rule.

Expected Completion Date for Review of NCD Request: 7/9/2003

Go to CAG-00188N for details.

Prothrombin Time and Partial Thromboplastin Time

(Revision of ICD-9-CM Codes for Pre-operative Examinations)

Issue: The current national coverage determination (NCD) for Prothrombin Time (PT) includes ICD-9-CM code V72.84, pre-operative examination, unspecified, in the list of covered diagnoses. CMS has received a request to add the other codes in the V72 series, specifically V72.81 pre-operative cardiovascular examination, V72.82, pre-operative respiratory examination, and V72.83, other specified pre-operative examination. The rationale for the request is that if V72.84 is covered, these other pre-operative codes should be covered as well. Consequently, CMS believes it is appropriate to consider the entire series of pre-operative codes as a unit. Thus, CMS will be examining codes V72.84 and V72.85 as well. Because the same issues pertain to the NCD for Partial Thromboplastin Time (PTT), CMS will also review the V72 series for PTT.

Updated tracking sheet extending the due date to: 6/30/2003.

Go to CAG-00184N for details.

NHIC

Updates for California

Retired LMRPs - June 1, 2003: CMS Adds Code for Screening Pap Smears

Effective for services on or after June 1, 2003, NHIC is retiring the following LMRPs:

Reference:  NHIC