The Centers for Medicare and Medicaid Services (CMS) issued Change Request (CR) 10859 and (CR) 11005 in November 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
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.
NCD20.7 Percutaneous Transluminal Angioplasty (PTA)
Medicare Administrative Contractors (MACs) are instructed to add ICD-10 codes I63.031, I63.032, I63.033, I63.131, I63.132, I63.133, and I63.233 to the list of covered ICD-10 codes effective October 1, 2015.
CMS further instructs MACs to end-date unspecified ICD-10 codes I66.9, I66.09, I66.19, and I66.29 effective April 1, 2019.
CMS instructs MACs to add ICD-10 codes N63.10 Unspecified lump in the right breast, unspecified quadrant and N63.20 Unspecified lump in the left breast, unspecified quadrant to the list of covered ICD-10 codes effective October 1, 2018.
Note: Dual diagnosis codes depicting specific quadrants can be reported instead of unspecified quadrants if found more appropriate by provider.
See MLN Matters articles MM 10859 and MM11005 for further details including a full list of affected NCDs.