May 14, 2018

CMS Updates ICD-10, Other Coding Revisions to NCDs

The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 10622 on May 4, 2018, containing coding updates to various National Coverage Determinations (NCD).

Modifications to radiology-relevant NCDs include the following:

  • NCD 220.13 Percutaneous Image-Guided Breast Biopsy – Effective October 1, 2018, Medicare administrative contractors (MACs) are instructed to add ICD-10 codes:
    • N63.10 Unspecified lump in the right breast, unspecified quadrant
    • N63.20 Unspecified lump in the left breast, unspecified quadrant
       
      NOTE: Dual diagnosis codes depicting specific quadrants can be reported instead of unspecified quadrants if found more appropriate by provider
  • NCD 220.6.17 PET for Solid Tumors –The CR instructs MACs to add back CPT code 78608, Brain imaging, positron emission tomography (PET); metabolic evaluation, which was inadvertently removed, end-date ICD-10 code R93.4 Abnormal findings on diagnostic imaging of urinary organs effective September 30, 2016, and revise the effective date of October 1, 2016 instead of October 1, 2017 for following ICD-10 codes:
    • R93.41 Abnormal radiologic findings on diagnostic imaging of renal pelvis, ureter, or bladder
    • R93.421 Abnormal radiologic findings on diagnostic imaging of right kidney
    • R93.422 Abnormal radiologic findings on diagnostic imaging of left kidney
    • R93.49 Abnormal radiologic findings on diagnostic imaging of other urinary organs

See MLN Matters article MM10622 for further details including a full list of affected NCDs.