Changes to Retroactive Coverage for LCD/Article ICD-10 Coding Revisions

Palmetto GBA has provided a 15 month period from October 1, 2015 to December 31, 2016 for stakeholders to identify inadvertent omissions of ICD-10 codes in LCDs/articles, that may have been a result of ICD-10 mapping conventions. These descriptions may not have been appropriate translations applicable to the specific LCD/article. Beginning January 1, 2017, all reconsideration requests to add diagnosis codes to existing LCDs, if the request is approved by Palmetto GBA, will be considered an expansion of existing coverage, rather than an inadvertent omission. Therefore, coverage will not be retroactive. Claims for DOS 10/1/2015 through 12/31/2016, may in some cases be eligible for adjustments or re-openings during this time frame, for ICD-10 diagnosis codes that were acknowledged by Palmetto GBA to have been inadvertently omitted from the LCD/article.