Changes to the Laboratory National Coverage Determination (NCD) Edit Software for January 2010
MLN Matters® Number: MM6717
Related Change Request (CR) #: 6717
Related CR Release Date: November 6, 2009
Effective Date: January 1, 2010
Related CR Transmittal #: R1847CP
Implementation Date: January 4, 2010
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, fiscal intermediaries (FIs), or Part A/B Medicare Administrative Contractors (A/B MACs)) for clinical diagnostic laboratory services provided for Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 6717 which announces the changes that will be included in the January 2010 release of Medicare’s edit module for clinical diagnostic laboratory National Coverage Determinations (NCDs). The last quarterly release of the edit module was issued in October 2009. Be sure billing staff are aware of the changes in this article.
Background
The NCDs for clinical diagnostic laboratory services were developed by the laboratory negotiated rulemaking committee and published in a final rule on November 23, 2001. Nationally uniform software was developed and incorporated in Medicare’s systems so that laboratory claims subject to one of the 23 NCDs were processed uniformly throughout the nation effective January 1, 2003.
In accordance with the Medicare Claims Processing Manual, Chapter 16, Section 120.2 (see http://www.cms.hhs.gov/manuals/downloads/clm104c16.pdf on the Centers for Medicare & Medicaid Services (CMS) website), the laboratory edit module is updated quarterly (as necessary) to reflect ministerial coding updates and substantive changes to the NCDs developed through the NCD process.
CR 6717 announces changes to the laboratory edit module for changes in laboratory NCD code lists for January 2010. These changes become effective for services furnished on or after January 1, 2010. The changes that are effective for dates of service on and after January 1, 2010 are as follows:
For Serum Iron Studies:
- Delete ICD-9-CM codes 453.50-453.52 from the list of ICD-9-CM codes that are covered by Medicare for the Serum Iron Studies (190.18) NCD.
For Gamma Glutamyl Transferase:
- Add ICD-9-CM codes 453.50-453.52 to the list of ICD-9-CM codes that are covered by Medicare for the Gamma Glutamyl Transferase (190.32) NCD.
NOTE: Effective dates for the following codes were inadvertently changed to July 1, 2009, with the July 1, 2009 quarterly release. The correct actual effective dates were October 1, 2007 and those dates will be reinstated with the January 2010 release of Medicare’s edit module.
For Prothrombin Time (PT):
- Revise the effective date from July 1, 2009, to October 1, 2007 for ICD-9-CM codes 200.30, 200.31, 200.32, 200.33, 200.34, 200.35, 200.36, 200.37, 200.38, 200.40, 200.41, 200.42, 200.43, 200.44, 200.45, 200.46, 200.47, 200.48, 200.50, 200.51, 200.52, 200.53, 200.54, 200.55, 200.56, 200.57, 200.58, 200.60, 200.61, 200.62, 200.63, 200.64, 200.65, 200.66, 200.67, 200.68, 200.70, 200.71, 200.72, 200.73, 200.74, 200.75, 200.76, 200.77, 200.78, 202.70, 202.71, 202.72, 202.73, 202.74, 202.75, 202.76, 202.77, and 202.78 that are listed for the Prothrombin Time (PT) (190.17) NCD.
For Serum Iron Studies:
- Revise the effective date from July 1, 2009, to October 1, 2007 for ICD-9-CM codes 200.30, 200.31, 200.32, 200.33, 200.34, 200.35, 200.36, 200.37, 200.38, 200.40, 200.41, 200.42, 200.43, 200.44, 200.45, 200.46, 200.47, 200.48, 200.50, 200.51, 200.52, 200.53, 200.54, 200.55, 200.56, 200.57, 200.58, 200.60, 200.61, 200.62, 200.63, 200.64, 200.65, 200.66, 200.67, 200.68, 200.70, 200.71, 200.72, 200.73, 200.74, 200.75, 200.76, 200.77, 200.78, 202.70, 202.71, 202.72, 202.73, 202.74, 202.75, 202.76, 202.77, and 202.78 that are listed for the Serum Iron Studies (190.18) NCD.
For Gamma Glutamyl Transferase:
- Revise the effective date from July 1, 2009, to October 1, 2007 for ICD-9-CM codes 200.30, 200.31, 200.32, 200.33, 200.34, 200.35, 200.36, 200.37, 200.38, 200.40, 200.41, 200.42, 200.43, 200.44, 200.45, 200.46, 200.47, 200.48, 200.50, 200.51, 200.52, 200.53, 200.54, 200.55, 200.56, 200.57, 200.58, 200.60, 200.61, 200.62, 200.63, 200.64, 200.65, 200.66, 200.67, 200.68, 200.70, 200.71, 200.72, 200.73, 200.74, 200.75, 200.76, 200.77, 200.78, 202.70, 202.71, 202.72, 202.73, 202.74, 202.75, 202.76, 202.77, and 202.78 that are listed for the Gamma Glutamyl Transferase (190.32) NCD.
Note that Medicare contractors will adjust claims affected by the above three categories if you bring such claims to their attention.
Additional Information
If you have questions, please contact the Palmetto GBA Provider Contact Center at our toll-free number, (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2009 American Medical Association.