NCD Coding Review - CR 10318-ICD-10 and Other Coding Revisions to NCDs

On January 18, 2018, CMS released Change Request (CR) 10318, Transmittal 2005 titled, “ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)”; it contains the latest coding instructions for CMS NCDs. We are bringing the following NCDs to your attention.

NCD 110.21 Erythropoiesis Stimulating Agents (ESAs) in Cancer
Business requirement (BR) 10318.10 specifically addresses coding changes and is in process of CMS’ review. Until this review is complete and CMS makes a final determination, the A/B MACs will not implement the edits contained in this CR. The A/B MACs will also reprocess any claims that were processed in error from January 1, 2018, that were processed with the additional codes included in CR 10318 as not payable with the EC modifier.

NCD 80.11 Vitrectomy
BRs 10318.21, 10318.21.1 and 10318.21.2 contain coding instructions for the vitrectomy NCD. CMS carefully reviews all coding revisions. While the review of the vitrectomy NCD is no exception, we realize that a large number of codes were removed and that has caused some concern among stakeholders. We appreciate all the stakeholders’ comments that notified CMS of the effect of the coding changes. As a result, CMS is in the process of a subsequent review of the codes marked for removal in CR 10318.

In the interim, codes included in the covered diagnosis list prior to CR 10318 are coverable. Any claims you and/or the MACs believe were processed in error as a result of CR 10318 will be reprocessed. Further, if you were advised by a MAC to hold NCD 80.11 claims until further notice, please be assured you can submit those claims and they will be processed without regard to CR 10318.

Once CMS has completed their review of coding for NCD 80.11 and if changes to CR 10318 are warranted, a subsequent CR will be released as well as directions to MACs indicating that decision, complete with specific implementation instructions.

If you are seeing problems with the Medicare Advantage plans concerning this please contact the Atlanta Regional office at 404-562-7500 or Part C/D complaints can be directed to: PARTDCOMPLAINTS_RO4@CMS.HHS.GOV.

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