Changes to the Lab NCD Edits

CR 3429 announces changes that will be included in the January 2005 release of the edit module for clinical diagnostic laboratory services. In accordance with the coding analysis published on the coverage Internet site on July 26, 2004, CMS is implementing the following:

For the urine culture and serum iron studies NCD, CMS is deleting the following ICD-9-CM code from the list of ICD-9-CM codes covered by Medicare: V72.84 (Pre-operative examination, unspecified).

Coverage for this code will terminate for services furnished on or after January 1, 2005. See: Decision Memo 127. In accordance with the coding analysis published on the coverage Internet site on July 27, 2004, CMS is implementing the following changes:

For the tumor antigen by immunoassay CA 125 NCD, CMS is adding the following ICD-9-CM diagnosis codes to the list of ICD-9-CM codes covered by Medicare:

• V10.41 (Personal history of malignant neoplasm, cervix uteri); and
• V10.42 (Personal history of malignant neoplasm, other parts of uterus).

Coverage for these codes will begin for services furnished on or after January 1, 2005. See: Decision Memo 132. In accordance with the coding analysis published on the coverage Internet site on July 28, 2004, CMS is implementing the following change:

• For the Prothrombin Time (PT) test NCD, CMS is removing the following ICD-9-CM diagnosis code from the list of ICD-9-CM codes covered by Medicare: V43.60 (Unspecified joint replaced by other means).

Coverage for this code will terminate for services furnished on or after January 01, 2005. See: Decision Memo 131.

To accommodate the new cardiovascular and diabetes screening benefits that were added to Medicare by the MMA, CMS is removing the following ICD-9-CM codes from the list of ICD-9-CM codes not covered by Medicare:

• V77.1 (Screening for Diabetes Mellitus)
• V81.0 (Screening for Ischemic Heart Disease)
• V81.1 (Screening for Hypertension)
• V81.2 (Screening for Other Unspecified Cardiovascular Conditions)

In order to implement the new cardiovascular and diabetes screening benefits that were added to Medicare by the MMA, CMS is making the following changes:

The lipid NCD edit is being subdivided into two parts:

• For Current Procedural Terminology (CPT) codes 80061 (Lipid panel), 82465 (Cholesterol, serum total), 83718 (Lipoprotein, direct, HDL), and 84478 (Triglycerides), CMS is adding the following ICD-9-CM diagnosis codes to the list of ICD-9-CM Codes covered by Medicare:
  • V81.0 (Screening for Ischemic Heart Disease)
  • V81.1 (Screening for Hypertension)
  • V81.2 (Screening for Other Unspecified Cardiovascular Conditions)
• The covered codes list for the remaining CPT codes in the lipid NCD (83715 [Lipoprotein, blood: electrophoretic separation and quantitation]), 83716 (High resolution fractionation and quantitation of lipoprotein cholesterols), and 83721 (Direct measurement, LDL cholesterol)) remain unchanged.
• For the diabetes benefit, the blood glucose NCD edit is being subdivided into two parts:
  • For CPT code 82947, CMS is adding the following ICD-9-CM diagnosis code to the list of ICD-9-CM Diagnosis Codes covered by Medicare: V77.1 (Screening for Diabetes Mellitus).
  • The covered codes for the remaining CPT codes in the blood glucose NCD (82948 (Glucose, blood, strip) and 82962 (Glucose (monitors)) remain unchanged.