August 13, 2019

CMS Issues ICD-10 and Other Coding Revisions to NCDs

On August 9, 2019, the Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 11392 containing coding revisions to a number of National Coverage Determinations (NCD) including those for NCD 150.3 Bone Mineral Density Studies, NCD 220.4 Mammography and NCD 220.13 Percutaneous Image-Guided Breast Biopsy. Below are the changes pertinent to radiology:

NCD150.3 Bone Mineral Density Studies

  •  Effective December 31, 2019, Medicare Administrative Contractors (MACs) will end-date International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes M85.9, M89.9, M94.9, and Q55.4
  • Starting on July 1, 2019 MACs will add CPT codes 0554T, 0555T, 0556T, 0557T, 0558T and apply the same rules applied to code 77078
    If there is no modifier on the HUBC claim form, MACs will post as both the professional component (PC) and technical component (TC)

NCD220.4 Mammography

  • Effective October 1, 2019, MACs will add ICD-10 diagnosis codes N63.15 and N63.25
  • Effective December 31, 2019, MACs will end-date the following ICD-10 diagnosis codes: C44.501, C44.509, C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, D49.2, D49.3, M70.90, M70.98, M70.99, M79.9, N60.91, N60.92, N63.10, N63.20, S21.001A, S21.002A, S29.001A, S29.009A, S29.9xxA, S39.001A, and S39.91xA

NCD220.13 Percutaneous Image-Guided Breast Biopsy

  • Effective October 1, 2019, MACs will add ICD-10 diagnosis codes N63.15, N63.25 to covered diagnosis list
  • MACs will end-date ICD-10 diagnosis codes C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, N63.10, and N63.20 effective December 31, 2019