November 13, 2018

CMS Updates ICD-10 and Makes Other Coding Revisions to NCDs

The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 10859 on November 8, 2018, containing coding updates to various National Coverage Determinations (NCDs).

Modifications to radiology-relevant NCDs include the following:

NCD 220.6.17 Positron Emission Tomography (PET) for Oncologic Conditions [LINK SPREADSHEET] –The CR instructs Medicare Administrative Contractors (MACs) to:  

  • End-date ICD-10 diagnosis codes, effective September 30, 2018: C43.11, C43.12, C44.102, C44.109, C44.112, C44.119, C44.122, C44.129, C44.192, C44.199, C4A.11, C4A.12

  • Add ICD-10 diagnosis codes, effective October 1, 2018: C43.111, C43.112, C43.121, C43.122, C44.1021, C44.1022, C44.1091, C44.1092, C44.1121, C44.1122, C44.1191, C44.1192, C44.1221, C44.1222, C44.1291, C44.1292, C44.1921, C44.1922, C44.1991, C44.1992, C4A.111, C4A.112, C4A.121, C4A.122

  • Delete ICD-10 diagnosis codes, effective January 1, 2019: C00.9, C02.9, C04.9, C05.9, C06.80, C06.9, C08.9, C10.9, C11.9, C13.9, C14.0, C15.9, C16.9, C17.9, C18.9, C21.0, C24.9, C25.9, C26.9, C31.9, C32.9, C34.91, C34.92, C4A.30, C4A.9, C44.310, C44.320, C44.390, C44.99, C45.9, C46.9, C47.9, C48.2, C51.9, C53.9, C54.9, C71.9, C72.50, C75.9, C7A.094, C7A.095, C7A.096, C79.10, R92.8

  • Add ICD-10 diagnosis codes, effective January 1, 2019: R77.9, R97.21, C7B.01, C7B.02, C7B.03, C7B.04, C7B.09, C7B.1, C7B.8, C88.0, C96.29, R97.21, Z85.020, Z85.028, Z85.030, Z85.040, Z85.05, Z85.060, Z85.068, Z85.07, Z85.09 , Z85.110, Z85.230, Z85.238, Z85.29, Z85.41, Z85.42, Z85.44, Z85.47, Z85.48, Z85.49, Z85.51, Z85.520, Z85.528, Z85.53, Z85.54, Z85.59, Z85.6, Z85.71, Z85.72, Z85.821, Z85.831, Z85.840, Z85.841, Z85.848, Z85.858, Z85.89

Note: CMS also instructs that whenever a personal history diagnosis code (Z85.XXX) is on a claim, the claim must also contain a diagnosis code from the list of covered C, D or R diagnosis codes.

See MLN Matters article MM 10859 for further details including a full list of affected NCDs.