General Surgery Coding Alert

Question: We’ve always turned to our Medicare contractor’s LCDs to find a list of payable diagnoses for procedures, but now we can’t find that information. What happened?

Codify Subscriber

Answer: CMS recently modernized the process for Local Coverage Determinations (LCDs) based on requirements of the 21st Century Cures Act. The process has resulted in changes to LCD content, including the decision to no longer include CPT^® or ICD-10 codes in the LCDs.

To implement the changes, CMS modified LCD instructions in chapter 13 of the Medicare Program Integrity Manual (100-08) and issued Change Request (CR) 10901 last year with a January 2019 start date. The updated manual states the following:

“It is no longer appropriate to include Current Procedure Terminology (CPT^®) codes or International Classification of Diseases-Tenth Revision-Clinical Modification (ICD-10-CM) codes in the LCDs. All CPT® and ICD-10 codes shall be removed from LCDs and placed in billing & coding articles or Policy Articles that are to be published to the MCD and related to the LCD.”

Implementation timelines may have varied in 2019 depending on your Medicare Administrative Contractors (MAC). If you have questions about where to find the CPT^® or ICD-10 codes relevant to a particular LCD, contact your MAC for direction.