Changes to NCDs

CR4005 announces changes to the list of codes included in the October 2005 release of the Medicare Laboratory National Coverage Determination (NCD) edit module for clinical diagnostic laboratory services. These changes are a result of new ICD-9-CM code changes that become effective October 01, 2005.

Immunodeficiency Virus (HIV) Testing (Diagnosis)

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Human Immunodeficiency Virus (HIV) Testing (Diagnosis). Those codes are as follows:

• 287.30 – Primary thrombocytopenia, unspecified
• 287.31 – Immune thrombocytopenic purpura
• 287.32 – Evans’ syndrome
• 287.33 – Congenital and hereditary thrombocytopenic purpura
• 287.39 – Other primary thrombocytopenia
• CMS is deleting ICD-9-CM code 287.3, Primary Thrombocytopenia, from the same list for this NCD

Blood Counts

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes That Do Not Support Medical Necessity for Medicare for Blood Counts. Those codes are as follows:

• 443.82 – Erythromelalgia V26.31 – Testing for genetic disease carrier status
• 525.40 – Complete edentulism, unspecified
• 525.41 – Complete edentulism, class I
• 525.42 – Complete edentulism, class II
• 525.43 – Complete edentulism, class III
• 525.44 – Complete edentulism, class IV
• 525.50 – Partial edentulism, unspecified
• 525.51 – Partial edentulism, class I
• 525.52 – Partial edentulism, class II
• 525.53 – Partial edentulism, class III
• 525.54 – Partial edentulism, class IV
• V26.32 – Other genetic testing
• V26.33 – Genetic counseling
• V49.84 – Bed confinement status
• V59.70 – Egg (oocyte) (ovum) donor, unspecified
• V59.71 – Egg (oocyte) (ovum) donor, under age 35,anonymous recipient
• V59.72 – Egg (oocyte) (ovum) donor, under age 35,designated recipient
• V59.73 – Egg (oocyte) (ovum) donor, age 35 and over,anonymous recipient
• V59.74 – Egg (oocyte) (ovum) donor, age 35 and over,designated recipient
• V62.84 – Suicidal ideation
• CMS is deleting ICD-9-CM code V26.3, Genetic Counseling and Testing, from the same list for this NCD.

Partial Thromboplastin Time (PTT)

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Partial Thromboplastin Time (PTT). Those codes are as follows:

• 287.30 – Primary thrombocytopenia, unspecified
• 287.31 – Immune thrombocytopenic purpura
• 287.32 – Evans’ syndrome
• 287.33 – Congenital and hereditary thrombocytopenic purpura
• 287.39 – Other primary thrombocytopenia
• 585.4 – Chronic kidney disease, Stage IV (severe)
• 585.5 – Chronic kidney disease, Stage V
• 585.6 – End stage renal disease
• 585.9 – Chronic kidney disease, unspecified
• CMS is deleting ICD-9-CM codes, 287.3, Primary Thrombocytopenia, and 585, Chronic Renal Failure, from the same list for this NCD.

Prothrombin Time (PT)

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Prothrombin Time (PT). Those codes are as follows:

• 287.30 – 287.39 as defined in the section on Partial Thromboplastin Time (PTT) above
• 443.82 Erythromelalgia
• 585.4 – 585.9 as defined in the section on Partial Thromboplastin Time (PTT) above
• CMS is deleting ICD-9-CM code, 287.3, Primary Thrombocytopenia, and 585, Chronic Renal Failure, from the same list for this NCD.

Serum Iron Studies

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Serum Iron Studies. Those codes are as follows:

• 287.30 – 287.39 as defined in the section on Partial Thromboplastin Time (PTT) above
• 585.4 – 585.9 as defined in the section on Partial Thromboplastin Time (PTT) above
• CMS is deleting ICD-9-CM codes 287.3, Primary Thrombocytopenia, and 585, Chronic Renal Failure, from the same list for this NCD

Blood Glucose Testing

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Blood Glucose Testing. Those codes as follows:

• 276.50 – Volume depletion, unspecified
• 276.51 – Dehydration
• 276.52 – Hypovolemia
• CMS is deleting ICD-9-CM code 276.5, Volume Depletion, from the same list for this NCD.

Thyroid Testing

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Thyroid Testing. Those codes are as follows:

• 327.00 – Organic insomnia, unspecified
• 327.01 – Insomnia due to medical condition classified elsewhere
• 327.09 – Other organic insomnia
• 327.29 – Other organic sleep apnea
• 327.52 – Sleep related leg cramp
• 327.8 – Other organic sleep disorders

Lipid Testing

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Lipid Testing. Those codes are as follows:

• 278.02 – Overweight
• 585.4 – 585.9 as defined in Partial Thromboplastin Time (PTT) above
• CMS is deleting ICD-9-CM code 585, Chronic Renal Failure, from the same list for this NCD.

Digoxin Therapeutic Drug Assay

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Digoxin Therapeutic Drug Assay. Those codes are as follows:

• 276.50 – Volume depletion, unspecified
• 276.51 – Dehydration
• 276.52 – Hypovolemia
• 426.82 – Long QT syndrome
• 585.1 – Chronic kidney disease, Stage I
• 585.2 – Chronic kidney disease, Stage II (mild)
• 585.3 – Chronic kidney disease, Stage III (moderate)
• 585.4 – Chronic kidney disease, Stage IV (severe)
• 585.5 – Chronic kidney disease, Stage V
• 585.6 – End stage renal disease
• 585.9 – Chronic kidney disease, unspecified
• CMS is deleting ICD-9-CM codes 276.5, Volume Depletion, and 585, Chronic Renal Failure, from the same list for this NCD.

Prostate Specific Antigen Testing

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Prostate Specific Antigen Testing. Those codes are as follows:

• 599.60 – Urinary obstruction, unspecified
• 599.69 – Urinary obstruction, not elsewhere classified
• CMS is deleting ICD-9-CM codes, 599.6, Urinary Obstruction, from the same list for this NCD.

Gamma Glutamyl Transferase Testing

CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Covered by Medicare for Gamma Glutamyl Transferase Testing. Those codes are as follows:

• 291.82 – Alcohol induced sleep disorders
• 567.21 – Peritonitis (acute) generalized
• 567.22 – Peritoneal abscess
• 567.23 – Spontaneous bacterial peritonitis
• 567.29 – Other suppurative peritonitis
• 567.38 – Other retroperitoneal abscess
• 567.39 – Other retroperitoneal infections
• 567.81 – Choleperitonitis
• 567.82 – Sclerosing mesenteritis
• 567.89 – Other specified peritonitis
• 585.6 – End Stage Renal Disease
• CMS is deleting ICD-9-CM codes, 567.2, Suppurat Peritonitis, 567.8, Peritonitis NEC and 585, Chronic Renal Failure, from the same list for this NCD.

Fecal Occult Blood Testing

CMS is adding ICD-9-CM codes

• 287.30 – 287.39 (as defined in Partial Thromboplastin Time (PTT) above) to the list of ICD-9-CM Codes Covered by Medicare for Fecal Occult Blood Testing. CMS is deleting ICD-9- CM code, 287.3, Primary Thrombocytopenia, from the same list for this NCD.

Negotiated Laboratory NCDs

In accordance with the coding analysis, CMS is adding new ICD-9-CM codes to the list of ICD-9-CM Codes Not Covered by Medicare for the Negotiated Laboratory NCDs. Those codes are as follows:

• V17.81 – Family history, Osteoporosis
• V17.89 – Family history, Other musculoskeletal diseases
• V18.9 – Family history, Genetic disease carrier
• CMS is deleting ICD-9-CM code, V17.8, Family history of certain chronic disabling diseases, from the same list.