Watch out for coding updates to a dozen national coverage determinations (NCDs), including big-ticket items such as mammography, to ensure your claims continue to get paid as ICD-10 turns one in October.
Released May 13, CMS' latest round of diagnosis-code revisions target 12 national coverage policies that providers will want to mark down as being subject to change. The edits, which delete and replace specific ICD-10 diagnosis codes, take effect Oct. 1, 2016.
Change request
9361, which contains the full revisions, is CMS' eighth maintenance update to the ICD-10 code set. It covers coding updates to the following NCDs:
- NCD 20.4 – Implantable Automatic Defibrillators
- NCD 20.7 – Percutaneous Transluminal Angioplasty (PTA)
- NCD 20.9 – Artificial Hearts
- NCD 20.29 – Hyperbaric Oxygen Therapy
- NCD 50.3 – Cochlear Implants
- NCD 110.18 – Aprepitant
- NCD 210.3 – Colorectal Cancer Screening
- NCD 220.4 – Mammography
- NCD 230.9 – Cryosurgery of Prostate
- NCD 260.9 – Heart Transplants
- NCD 210.4 – Smoking/Tobacco-Use Cessation Counseling
- NCD 210.4.1 – Counseling to Prevent Tobacco Use
In related
MLN Matters article 9631, CMS noted that the NCDs in question are not subject to policy updates. Rather, the updates correspond to providers and payers understanding ICD-10 more thoroughly, as "there may be certain ICD-9 codes that were once considered appropriate prior to ICD-10 implementation that are no longer considered acceptable," states the MLN Matters article.
For instance, the revisions added two diagnosis codes to the hyperbaric oxygen therapy NCD, L59.8 (Other specified disorders of the skin and subcutaneous tissue related to radiation) and M27.2 (Inflammatory conditions of jaws), while deleting two other diagnosis codes that will unusable come October – L59.9 (Disorder of the skin and subcutaneous tissue related to radiation, unspecified) and M27.8 (Other specified disease of jaws).
The revisions removed unspecified codes from the mammography NCD, as CMS evidenty seeks to make ICD-10 coding more exact.