NCD

CMS has released the October 2006 update to its Medicare National Coverage Determinations (NCDs) Manual for Clinical Diagnostic Laboratory Services. This update, requires updating of the laboratory edit module. These changes become effective for services furnished on or after October 01, 2006. Changes are being made to the NCD code lists for services furnished on or after October 01, 2006, are as follows:

190.12 – Urine Culture, Bacterial

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Urine Culture, Bacterial (190.12) NCD: ICD-9-CM codes 288.00, 288.01, 288.02, 288.03, 288.04, 288.09, 608.20, 608.21, 608.22, 608.23, 608.24, 616.81, 616.89, 780.96, 780.97, 788.64 and 788.65

The following ICD-9-CM codes are being deleted from the list of ICD-9-CM codes covered by Medicare for the Urine Culture, Bacterial (190.12) NCD: ICD-9-CM codes 288.0, 608.2 and 616.8

190.14 – Human Immunodeficiency Virus (HIV) Testing (Diagnosis)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) NCD: ICD-9-CM codes 052.2, 053.14, 054.74, 288.00, 288.01, 288.02, 288.03, 288.04, 288.09, 288.4, 288.50, 288.51, 288.59, 288.60, 288.61, 288.62, 288.63, 288.64, 288.65, 288.69, 289.53 and 331.83

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) NCD: ICD-9-CM code 288.0

190.15 – Blood Counts

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes that do not support medical necessity for the Blood Counts (190.15) NCD: ICD-9-CM codes 338.0, 338.11, 338.12, 338.18, 338.19, 338.21, 338.22, 338.28, 338.29, 338.4, 389.15, 389.16, 478.11, 478.19, 521.81, 521.89, 525.60, 525.61, 525.62, 525.63, 525.64, 525.65, 525.66, 525.67, 525.69, 526.61, 526.62, 526.63, 526.69, 608.20, 608.21, 608.22, 608.23, 608.24, 618.84, V26.34, V26.35, V45.86, V72.11 and V72.19

ICD-9-CM codes 521.8 and V72.1 are deleted from the list of codes that do not support medical necessity for the Blood Counts (190.15) NCD.

190.16 – Partial Thromboplastin Time (PTT)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Partial Thromboplastin Time (PTT)(190.16) NCD: ICD-9-CM codes 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, 238.79, 277.30, 277.31, 277.39, 289.81, 649.30, 649.31, 649.32, 649.33, 649.34, 649.50, 649.51, 649.53, 998.12, 995.20, 995.21, 995.27, and 995.29

The following ICD-9-CM codes are being deleted from the list of ICD-9-CM codes covered by Medicare for the Partial Thromboplastin Time (PTT)(190.16) NCD: ICD-9-CM codes 238.7, 277.3 and 995.2

190.17 – Prothrombin Time (PT)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Prothrombin Time (PT) (190.17) NCD: ICD-9-CM codes 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, 238.79, 277.30, 277.31, 277.39, 289.81, 649.30, 649.31, 649.32, 649.33, 649.34, 649.50, 649.51, 649.53, 995.20, 995.21, 995.27 and 995.29

The following ICD-9-CM codes are being deleted from the list of ICD-9-CM codes covered by Medicare for the Prothrombin Time (PT) (190.17) NCD: ICD-9-CM codes 238.7, 277.3 and 995.2

190.18 – Serum Iron Studies

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Serum Iron Studies (190.18) NCD: ICD-9-CM codes 238.71, 238.72, 238.73, 238.74, 238.75, 238.76 and 238.79

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Serum Iron Studies (190.18) NCD: ICD-9-CM code 238.7

190.20 – Blood Glucose Testing

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Blood Glucose Testing (190.20) NCD: ICD-9-CM codes 331.83, 528.00, 528.09, 649.20, 649.21, 649.22, 649.23, 649.24 and 780.32

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Blood Glucose Testing (190.20) NCD: ICD-9-CM code 528.0

190.22 – Thyroid Testing

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Thyroid Testing (190.22) NCD: ICD-9-CM codes 331.83, 780.96 and 780.97

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Thyroid Testing (190.22) NCD ICD-9-CM code 793.9

190.23 – Lipids Testing

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Lipids Testing (190.23) NCD: ICD-9-CM codes 277.30, 277.31 and 277.39

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Lipids Testing (190.23) NCD: ICD-9-CM code 277.3

190.24 – Digoxin Therapeutic Drug Assay

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Digoxin Therapeutic Drug Assay (190.24) NCD: ICD-9-CM codes 995.20, 995.21, 995.27 and 995.29

The following ICD-9-CM code is being deleted from the list of ICD-9-CM codes covered by Medicare for the Digoxin Therapeutic Drug Assay (190.24) NCD: ICD-9-CM code 995.2

190.25 – Alpha-fetoprotein

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Alpha-fetoprotein (190.25) NCD: ICD-9-CM codes V86.0, V86.1, 795.89 and 338.3

190.26 – Carcinoembryonic Antigen

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Carcinoembryonic Antigen (190.26) NCD: ICD-9-CM codes 795.81, 795.89 and 338.3

190.27 – Human Chorionic Gonadotropin

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Human Chorionic Gonadotropin (190.27) NCD: ICD-9-CM codes 795.89 and 338.3

190.28 – Tumor Antigen by Immunoassay CA 125

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Tumor Antigen by Immunoassay CA 125 (190.28) NCD: ICD-9-CM codes 795.82, 795.89 and 338.3

190.29 – Tumor Antigen by Immunoassay CA 15-3/CA27.29

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Tumor Antigen by Immunoassay CA 15-3/CA27.29 (190.29) NCD: ICD-9-CM codes 338.3 and 795.89

190.30 – Tumor Antigen by Immunoassay CA 19.9

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Tumor Antigen by Immunoassay CA 19.9 (190.30) NCD: ICD-9-CM codes 338.3 and 795.89

190.31 – Prostate Specific Antigen (PSA)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Prostate Specific Antigen (PSA) (190.31) NCD: ICD-9-CM codes 600.00, 600.10, 600.11, 600.21, 788.64 and 788.65.

190.32 – Gamma Glutamyl Transferase (GGT)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Gamma Glutamyl Transferase (GGT) (190.32) NCD: ICD-9-CM codes 238.71, 238.72, 238.73, 238.74, 238.75, 238.76, 238.79, 277.30, 277.31 and 277.39

The following ICD-9-CM codes are being deleted from the list of ICD-9-CM codes covered by Medicare for the Gamma Glutamyl Transferase (GGT) (190.32) NCD: ICD-9-CM codes 238.7 and 277.3

190.33 – Hepatitis Panel/Acute Hepatitis Panel

The following ICD-9-CM code of 780.32 is being added to the list of ICD-9-CM codes covered by Medicare for the Hepatitis Panel/Acute Hepatitis Panel (190.33) NCD.

190.34 – Fecal Occult Blood Test (FOBT)

The following ICD-9-CM codes are being added to the list of ICD-9-CM codes covered by Medicare for the Fecal Occult Blood Test (FOBT) (190.34) NCD: ICD-9-CM codes 284.2 and 338.3

The following ICD-9-CM codes are being deleted from the list of ICD-9-CM codes covered by Medicare for the Fecal Occult Blood Test (FOBT) (190.34) NCD: ICD-9-CM code 995.2

List of denied ICD-9-CM codes for all NCDs

The following ICD-9-CM codes are being added to the list of denied ICD-9-CM codes for all NCDs: ICD-9-CM codes V18.51, V18.59, V82.71 and V82.79

ICD-9-CM code V18.5 is deleted from the list of denied ICD-9-CM codes for all NCDs.