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.