Changes to the Laboratory National Coverage Determination (NCD) Edit Software for October 2011: Revised article

The CR was revised to add some codes and delete some codes from the various NCD policies. The changes are indicated in red below.

For codes that are Covered by Medicare for the HIV Testing:
• Add ICD-9-CM codes 512.81, 512.82, and 512.83 to the list of codes covered by Medicare for HIV Testing (Diagnosis) (190.14) NCD.
• Delete ICD-9-CM code 512.8 from that same list.

For Codes That Do Not Support Medical Necessity For The Blood Counts
• Add ICD-9-CM codes 726.13, V40.31, V40.39, and V54.82 to the list of ICD-9-CM codes that Do Not Support Medical Necessity for the Blood Counts (190.15) NCD.
• Delete ICD-9-CM codes 718.60 and V40.3 from that list.

For Prothrombin Time
• Delete ICD-9-CM codes 286.5, 425.1, 444.0, 596.8, and 997.4 from the list of ICD-9-CM codes that are covered by Medicare for the Prothrombin Time (PT) (190.17) NCD.
• Add ICD-9-CM codes 286.52, 286.53, 286.59, 414.4, 415.13, 425.11, 425.18, 444.01, 444.09, 573.5, 596.81, 596.82, 596.83, 596.89, 997.41, 997.49, and V12.55 to the list of ICD-9-CM codes that are covered by Medicare for the Prothrombin Time (PT) (190.17) NCD.

For Serum Iron Studies
• Add ICD-9-CM codes 173.00, 173.01, 173.02, 173.09, 173.10, 173.11, 173.12, 173.19, 173.20, 173.21, 173.22, 173.29, 173.30, 173.31, 173.32, 173.39, 173.40, 173.41, 173.42, 173.49, 173.50, 173.51, 173.52, 173.59, 173.60, 173.61, 173.62, 173.69, 173.70, 173.71, 173.72, 173.79, 173.80, 173.81, 173.82, 173.89, 173.90, 173.91, 173.92, 173.99, 282.40, 282.43, 282.44, 282.45, 282.46, 282.47, 286.52, 286.53, 286.59, and 573.5 to the list of ICD-9-CM codes that are covered by Medicare for the Serum Iron Studies (190.18) NCD.

For Blood Glucose Testing
• Add ICD-9-CM codes 414.4, V23.42 and V23.87 to the list of ICD-9-CM codes that are covered by Medicare for the Blood Glucose Testing (190.20) NCD.

For Lipids Testing
• Add ICD-9-CM codes 414.4, 444.01, 444.09, and 573.5 to the list of ICD-9-CM codes that are covered by Medicare for the Lipids Testing (190.23) NCD.

For Digoxin Therapeutic Drug Assay:
• Add ICD-9-CM codes 414.4, 425.11, 425.18, 444.01, 44.09, and 573.5 to the list of codes covered by Medicare for the Digoxin Therapeutic Drug Assay (190.24) NCD.

For Alpha-fetoprotein:
• Delete ICD-9-CM codes 425.1 and 793.1 from the list of codes covered by Medicare for the Alpha-fetoprotein (190.25) NCD.
• Add ICD-9-CM codes 414.4, 425.11, 425.18, 444.01, 444.09, 573.5, 793.11, and 793.19 to the same list of covered codes.

For Gamma Glutamyl Transferase:
• Add ICD-9-CM codes 173.00, 173.01, 173.02, 173.09, 173.10, 173.11, 173.12, 173.19, 173.20, 173.21, 173.22, 173.29, 173.30, 173.31, 173.32, 173.39, 173.40, 173.41, 173.42, 173.49, 173.50, 173.51, 173.52, 173.59, 173.60, 173.61, 173.62, 173.69, 173.70, 173.71, 173.72, 173.79, 173.80, 173.81, 173.82, 173.89, 173.90, 173.91, 173.92, 173.99, and 573.5 to the list of ICD-9-CM codes that are covered by Medicare for the Gamma Glutamyl Transferase (190.32) NCD.

Add ICD-9-CM code 573.5 to the list of codes covered by Medicare for the Hepatitis Panel/Acute Hepatitis Panel (190.33) NCD.