January 08, 2020

NCD ICD-10 Diagnosis Code Changes Announced for April 2020 Update

The Centers for Medicare and Medicaid Services issued Change Request 11491 on November 1, 2019, containing coding updates to various National Coverage Determinations (NCDs).

These code changes will take effect on April 1, 2020. Medicare Administrative Contractors are issuing guidance to mitigate claims processing errors. Make sure your billing staff is aware of these changes.

Modifications to radiology-relevant NCDs include the following:

NCD 210.3 Colorectal Cancer Screening Code Changes

  • Add ICD-10 diagnosis code Z86.004 to covered codes effective Oct. 1, 2019
  • End-date ICD-10 diagnosis codes C18.9 and D12.6 effective Sept. 30, 2019
  • Add CPT code 74263 as non-covered for Part B omitted in error

Note: Because new diagnosis codes for these NCDs will not be added until April 1, 2020, services included in these NCDs with the new diagnoses codes for date of service on or after Oct. 1, 2019 will be denied.

Part B providers are advised to refrain from submitting appeals for any denials received between Oct. 1, 2019 and April 1, 2020, since earlier claim submissions will result in denials. Claims denied as a result of this issue may not be appealed until April 1, 2020. Appeals submitted prior to that date will be affirmed.

See MLN Matters article MM 11491 for details including a full list of affected NCDs.