Laboratory National Coverage Determination (NCD) Edits

This article announces the changes that will be included in the April 2009 release of the edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs).

• For Blood Counts (190.15):
  Add ICD-9-CM codes 525.71, 525.72 and 525.73 to the list of ICD-9-CM codes that do not support medical necessity.
• For Partial Thromboplastin Time (PTT) (190.16):
  Add ICD-9-CM codes 535.70 and 535.71 to the list of ICD-9-CM codes covered by Medicare.
• For Prothrombin Time (PT) (190.17):
  Add ICD-9-CM codes 414.3, 535.70, and 535.71 to the list of ICD-9-CM codes covered by Medicare.
• For Serum Iron Studies (190.18):
  Add ICD-9-CM codes 203.02, 203.12, 203.82, 204.02, 204.12, 204.22, 204.82, 204.92, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 206.02, 206.12, 206.22, 206.82, 206.92, 207.02, 207.12, 207.22, 207.82, 208.02, 208.12, 208.22, 208.82, 208.92, 535.70, and 535.71 to the list of ICD-9-CM codes covered by Medicare.
• For Blood Glucose Testing (190.20):
  Add ICD-9-CM code 414.3 to the list of ICD-9-CM codes covered by Medicare.
• For Lipids Testing (190.23):
  Add ICD-9-CM code 414.3 to the list of ICD-9-CM codes covered by Medicare.
• For Gamma Glutamyl Transferase (190.32):
  Add ICD-9-CM codes 203.02, 203.12, 203.82, 204.02, 204.12, 204.22, 204.82, 204.92, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 206.02, 206.12, 206.22, 206.82, 206.92, 207.02, 207.12, 207.22, 207.82, 208.02, 208.12, 208.22, 208.82, and 208.92 to the list of ICD-9-CM codes covered by Medicare.
• For Fecal Occult Blood Test (FOBT) (190.34):
  Add ICD-9-CM codes 204.02, 204.12, 204.22, 204.82, 204.92, 205.02, 205.12, 205.22, 205.32, 205.82, 205.92, 206.02, 206.12, 206.22, 206.82, 206.92, 207.02, 207.12, 207.22, 207.82, 208.02, 208.12, 208.22, 208.82, 208.92, 535.70 and 535.71 to the list of ICD-9-CM codes covered by Medicare.