Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report October 2012 Clinical Diagnostic Laboratory Services Health & Human Services Department Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 CMS Email Point of Contact: [email protected] TDD 410.786.0727 Fu Associates, Ltd. Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. NCD Manual Changes Date Reason Release Change Edit *The following section represents NCD Manual updates for October 2012. *10/01/12 *There were no CR updates for October 2012. The following section represents NCD Manual updates for July 2012. 07/01/12 There were no CR updates for July 2012. The following section represents NCD Manual updates for April 2012. 04/01/12 ICD-9-cm code range 2012200 376.21-376.22 (190.15) Blood Counts and descriptors revised Endocrine exophthalmos 376.21-376.9 Disorders of the orbit, except 376.3 376.40-376.47 Other exophthalmic Deformity of orbit conditions (underlining in original) 376.50-376.52 Enophthalmos 376.6 Retained (old) foreign body following penetrating wound of orbit 376.81-376.82 Orbital cysts; myopathy of extraocular muscles 376.89 Other orbital disorders 376.9 Unspecified disorder of orbit The following section represents NCD Manual updates for January 2012. 01/01/12 Per CR 7621 add ICD-9- 2012100 786.50 Chest pain, (190.17) Prothrombin Time CM codes 786.50 and unspecified (PT) 786.51 to the list of ICD- 9-CM codes that are 786.51 Precordial pain covered by Medicare for the Prothrombin Time (PT) (190.17) NCD. Transmittal # 2344 *October 12 Changes – Red Fu Associates, Ltd. October 2012 ii Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 01/01/12 Per CR 7621 delete ICD- 2012100 425.11 Hypertrophic (190.25) Alpha-fetoprotein 9-CM codes 425.11 and obstructive cardiomyopathy 425.18 from the list of ICD-9-CM codes that are 425.18 Other hypertrophic covered by Medicare for cardiomyopathy the Alpha-fetoprotein (190.25) NCD. Transmittal # 2344 The following section respresents NCD Manual updates for October 2011. 10/01/11 Per CR 7507 delete ICD- 2011400 V19.1 Family history of All NCD Edits 9-CM code V19.1 from other eye disorders the list of ICD-9-CM codes that are denied by Medicare for all 23 Lab NCDs. Transmittal # 2298 10/01/11 Per CR 7507 add ICD-9- 2011400 V19.11 Family history of All NCD Edits CM codes V19.11 and glaucoma V19.19 to the list of ICD- 9-CM codes that are V19.19 Family history of denied by Medicare for other specified eye disorder all 23 Lab NCDs. Transmittal # 2298 10/01/11 Per CR 7507 delete ICD- 2011400 512.8 Other spontaneous 190.14 Human 9-CM code 512.8 from pneumothorax Immunodeficiency Virus the list of ICD-9-CM (HIV) Testing (Diagnosis) codes that are covered by Medicare for the Human Immunodeficiency Virus (HIV) Testing (Diagnosis) (190.14) NCD. Transmittal # 2298 *October 12 Changes – Red Fu Associates, Ltd. October 2012 iii Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 add ICD-9- 2011400 512.81 Primary 190.14 Human CM codes 512.81, spontaneous pneumothorax Immunodeficiency Virus 512.82, and 512.83 to (HIV) Testing (Diagnosis) the list of ICD-9-CM 512.82 Secondary codes that are covered spontaneous pneumothorax by Medicare for the Human Immunodeficiency Virus 512.83 Chronic (HIV) Testing pneumothorax (Diagnosis) (190.14) NCD. Transmittal # 2298 10/01/11 Per CR 7507 delete ICD- 2011400 718.60 Unspecified 190.15 Blood Counts 9-CM codes 718.60 and intrapelvic protrusion of V40.3 from the list of acetabulum, site unspecified ICD-9-CM codes that Do Not Support Medical V40.3 Other behavioral Necessity for the Blood problems Counts (190.15) NCD. Transmittal # 2298 10/01/11 Per CR 7507 add ICD-9- 2011400 726.13 Partial tear of rotator 190.15 Blood Counts CM codes 726.13, cuff V40.31, V40.39, and V54.82 to the list of ICD- V40.31 Wandering in 9-CM codes that Do Not diseases classified Support Medical elsewhere Necessity for the Blood Counts (190.15) NCD. V40.39 Other specified behavioral problem Transmittal # 2298 V54.82 Aftercare following explantation of joint prosthesis *October 12 Changes – Red Fu Associates, Ltd. October 2012 iv Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 delete ICD- 2011400 286.5 Hemorrhagic 190.16 Partial 9-CM codes 286.5, disorder due to intrinsic Thromboplastin Time (PTT) 444.0, and 596.8 from circulating anticoagulants the list of ICD-9-CM codes that are covered 444.0 Embolism and by Medicare for the thrombosis of abdominal Partial Thromboplastin aorta Time (PTT) (190.16) NCD. 596.8 Other specified disorders of bladder Transmittal # 2298 10/01/11 Per CR 7507 add ICD-9- 2011400 286.52 Acquired hemophilia 190.16 Partial CM codes 286.52, Thromboplastin Time (PTT) 286.53, 286.59, 444.01, 286.53 Antiphospholipid 444.09, 573.5, 596.81, antibody with hemorrhagic 596.82, 596.83, and disorder 596.89 to the list of ICD- 9-CM codes that are covered by Medicare for 286.59 Other hemorrhagic the Partial disorder due to intrinsic Thromboplastin Time circulating anticoagulants, (PTT) (190.16) NCD. antibodies, or inhibitors Transmittal # 2298 444.01 Saddle embolus of abdominal aorta 444.09 Other arterial embolism and thrombosis of abdominal aorta 573.5 Hepatopulmonary syndrome 596.81 Infection of cystostomy 596.82 Mechanical complication of cystostomy 596.83 Other complication of cystostomy 596.89 Other specified disorders of bladder *October 12 Changes – Red Fu Associates, Ltd. October 2012 v Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 delete ICD- 2011400 286.5 Hemorrhagic disorder 190.17 Prothrombin Time 9-CM codes 286.5, due to intrinsic circulating (PT) 425.1, 444.0, 596.8, and anticoagulants 997.4 from the list of ICD-9-CM codes that are 425.1 Hypertrophic covered by Medicare for obstructive cardiomyopathy the Prothrombin Time (PT) (190.17) NCD. 444.0 Embolism and thrombosis of abdominal Transmittal # 2298 aorta 596.8 Other specified disorders of bladder 997.4 Digestive system complications, not elsewhere classified *October 12 Changes – Red Fu Associates, Ltd. October 2012 vi Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 add ICD-9- 2011400 286.52 Acquired hemophilia 190.17 Prothrombin Time CM codes 286.52, 286.53 Antiphospholipid (PT) 286.53, 286.59, 414.4, antibody with hemorrhagic 415.13, 425.11, 425.18, disorder 444.01, 444.09, 573.5, 286.59 Other hemorrhagic 596.81, 596.82, 596.83, disorder due to intrinsic 596.89, 997.41, 997.49, circulating anticoagulants, and V12.55 to the list of antibodies, or inhibitors ICD-9-CM codes that are covered by Medicare for the Prothrombin Time 414.4 Coronary (PT) (190.17) NCD. atherosclerosis due to calcified coronary lesion Transmittal # 2298 415.13 Saddle embolus of pulmonary artery 425.11 Hypertrophic obstructive cardiomyopathy 425.18 Other hypertrophic cardiomyopathy 444.01 Saddle embolus of abdominal aorta 444.09 Other arterial embolism and thrombosis of abdominal aorta 573.5 Hepatopulmonary syndrome 596.81 Infection of cystostomy 596.82 Mechanical complication of cystostomy 596.83 Other complication of cystostomy 596.89 Other specified disorders of bladder 997.41 Retained cholelithiasis following cholecystectomy 997.49 Other digestive system complications V12.55 Personal history of pulmonary embolism *October 12 Changes – Red Fu Associates, Ltd. October 2012 vii Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 delete ICD- 2011400 173.0 Other malignant 190.18 Serum Iron Studies 9-CM codes 173.0, neoplasm of skin of lip 173.1, 173.2, 173.3, 173.4, 173.5, 173.6, 173.1 Other malignant 173.7, 173.8, 173.9, and neoplasm of skin of eyelid, 286.5 from the list of including canthus ICD-9-CM codes that are covered by Medicare for the Serum Iron Studies 173.2 Other malignant (190.18) NCD. neoplasm of skin of ear and external auditory canal Transmittal # 2298 173.3 Other malignant neoplasm of skin of other and unspecified parts of face 173.4 Other malignant neoplasm of scalp and skin of neck 173.5 Other malignant neoplasm of skin of trunk, except scrotum 173.6 Other malignant neoplasm of skin of upper limb, including shoulder 173.7 Other malignant neoplasm of skin of lower limb, including hip 173.8 Other malignant neoplasm of other specified sites of skin 173.9 Other malignant neoplasm of skin, site unspecified 286.5 Hemorrhagic disorder due to intrinsic circulating anticoagulants *October 12 Changes – Red Fu Associates, Ltd. October 2012 viii Medicare National Coverage Determinations (NCD) Coding Policy Manual and Change Report This is CMS Logo. Date Reason Release Change Edit 10/01/11 Per CR 7507 add ICD-9- 2011400 173.00 Unspecified 190.18 Serum Iron Studies CM codes 173.00, malignant neoplasm of skin 173.01, 173.02, 173.09, of lip 173.10, 173.11, 173.12, 173.19, 173.20, 173.21, 173.01 Basal cell carcinoma 173.22, 173.29, 173.30, of skin of lip 173.31, 173.32, 173.39, 173.40, 173.41, 173.42, 173.49, 173.50, 173.51, 173.02 Squamous cell 173.52, 173.59, 173.60, carcinoma of skin of lip 173.61, 173.62, 173.69, 173.70, 173.71, 173.72, 173.09 Other specified 173.79, 173.80, 173.81, malignant neoplasm of skin 173.82, 173.89, 173.90, of lip 173.91, 173.92, 173.99, 282.40, 282.43, 282.44, 173.10 Unspecified 282.45, 282.46, 282.47, malignant neoplasm of 286.52, 286.53, 286.59, eyelid, including canthus and 573.5 to the list of ICD-9-CM codes that are covered by Medicare for 173.11 Basal cell carcinoma the Serum Iron Studies of eyelid, including canthus (190.18) NCD.