NCD – Changes to the Edit Software

Effective January 1, 2004, the following changes will be made to the laboratory edit software:

The following diagnosis codes are added to the list of ICD-9-CM Codes covered by Medicare for the prothrombin time (PT) and fecal occult blood test (FOBT) NCDs:

• 863.91 pancreas head with open wound into cavity
• 863.92 pancreas body with open wound into cavity
• 863.93 pancreas tail with open wound into cavity
• 863.94 pancreas multiple and unspecified sites with open wound into cavity
• 863.95 appendix with open wound into cavity
• 863.99 other gastrointestinal sites with open wound into cavity

The following diagnosis codes are deleted from the list of ICD-9-CM Codes covered by Medicare for PT and partial thromboplastin time (PTT) NCDs:

• V72.81 pre-operative cardiovascular examination (from PTT)
• V72.83 other specified pre-operative examination (from PTT)
• V72.84 pre-operative examination, unspecified (from PT and PTT)

In Program Memorandum AB-03-104 (CR 2814), CMS announced the addition of diagnosis code 401.1, benign essential hypertension, to the list of covered diagnoses for lipid testing. However, they did not announce the corresponding change to the narrative of the lipid NCD that authorizes this code. By inclusion in this transmittal, CMS is announcing a change to the narrative of the lipid NCD that was included in the July 17, 2003 decision memorandum posted on the CMS website. The third bullet listed in the lipid NCD indications section is amended to read: “Any form of atherosclerotic disease, or any disease leading to the formation of atherosclerotic disease.”

In Program Memorandum AB-03-104, CMS announced a number of ICD-9-CM codes that were deleted by the update in ICD-9-CM codes that became effective October 1, 2003. CMS provided for a 90-day grace period for the provider and laboratory community to adapt to these changes. Thus, while CMS announced the changes in CR 2814, they did not alter the software to deny claims when these codes were used. However, the grace period expires with the January update of the software and the following ICD-9-CM codes will be denied: 282.4, 331.1, 348.3, 530.2, 600.0, 600.1, 600.2, 600.9, 767.1, 790.2, V04.8, V43.2, V53.9, V54.0 and V65.1.