National Coverage Determination Update

Changes that will be included in the October 2004 release of the edit module for clinical diagnostic laboratory services are as follows.

Deleting the following diagnosis codes for the urine culture NCD:

• 584.5 Acute renal failure, with lesion of tubular necrosis
• 584.9 Acute renal failure, unspecified
• 586 Renal failure, unspecified

Coverage for these codes will terminate for services furnished on or after October 1, 2004.

The following code is being added for the prothrombin time (PT) and partial thromboplastin time (PTT) NCDs.

• 729.81 Swelling of limb

Coverage for this code will begin for services furnished on or after October 1, 2004.

The following code is being added for the prostate specific antigen (PSA) test NCD.

• 600.01 Benign prostate hypertrophy with urinary obstruction

Coverage for this code will begin for services furnished on or after October 1, 2004.

To accommodate the new ICD-9-CM coding the following changes are occurring. These changes become effective for services furnished on or after October 1, 2004.

Adding a new ICD-9-CM code to the list covered by Medicare for urine culture NCD:

• 788.38

Adding new ICD-9-CM codes to the list covered by Medicare for HIV testing (diagnosis):

• 070.70, 070.71, 588.81, 588.89, V01.71, V01.79

Terminating coverage of ICD-9-CM codes, effective with services furnished on or after October 12, 2004:

• V01.7, 588.8

Adding new ICD-9-CM codes to the list that do not support medical necessity for the blood counts NCD:

• 521.06, 521.07, 521.08, 521.10 – 521.15, 521.20 – 521.25, 521.30 – 521.35, 521.40 – 521.42, 521.49, 524.07, 524.20 – 524.37, 524.39, 524.50 – 524.57, 524.59, 524.64, 524.75, 524.76, 524.81, 524.82, 524.89, 525.20 – 525.26, 618.00 – 618.05, 618.09, 618.81 – 618.83, 618.89, 692.84, V72.40, V72.41

Removing the following ICD-9-CM codes from the list that are no longer valid:

• 521.1, 521.2, 521.3, 521.4, 524.2, 524.3, 524.5, 524.8, 525.2, 618.0, 618.8, V72.4

Adding new ICD-9-CM codes to the list covered by Medicare for the partial thromboplastin time NCD:

• 070.70, 070.71, 453.40 – 453.42

Adding new ICD-9-CM codes to the list of covered diagnoses for the prothrombin time NCD:

• 070.70, 070.71, 453.40 – 453.42, 530.86, 530.87

Adding new ICD-9-CM codes to the list of covered diagnoses for the serum iron studies NCD:

• 070.70, 070.71

Adding new ICD-9-CM codes to the list of covered diagnoses for the collagen crosslinks NCD:

• 252.00 – 252.02, 252.08

Removing the following ICD-9-CM code from the list that is no longer valid:

• 252.0

Adding new ICD-9-CM codes to the list of covered diagnoses for the blood glucose testing NCD:

• 491.22, 707.00 – 707.07, 707.09, V58.67

Removing the following ICD-9-CM code from the list that is no longer valid:

• 707.0

Adding a new ICD-9-CM code to the list of covered diagnoses for glycated hemoglobin.

• V58.67

Adding new ICD-9-CM codes to the list of covered diagnoses for the lipid testing NCD:

• 588.81, 588.89

Removing the following ICD-9-CM code from the list that is no longer valid:

• 588.8

Adding new ICD-9-CM codes to the list of covered diagnoses for the digoxin therapeutic drug assay NCD:

• 588.81, 588.89

Removing the following ICD-9-CM code from the list that is no longer valid:

• 588.8

Adding a new ICD-9-CM code to the list of covered diagnoses for alpha-fetoprotein:

• 273.4

Adding new ICD-9-CM codes to the list of covered diagnoses for the gamma glutamyl transferase NCD:

• 070.70, 070.71, 252.00 – 252.02, 252.08, 273.4, 453.40 – 453.42, 588.81, 588.89

Removing the following ICD-9-CM code from the list that is no longer valid:

• 252.0, 588.8

Adding a new ICD-9-CM codes to the list of covered diagnoses for the hepatitis panel NCD:

• 070.70, 070.71

Adding a new ICD-9-CM code to the list of covered diagnoses for the fecal occult blood test.

• V58.66