Pathology/Lab Coding Alert

NCD update uses new ICD-9 codes

Throw out those four-digit codes and break out the expanded five-digit versions if you want to get paid for lab tests. That's what the latest National Coverage Determination says by adding a host of new five-digit ICD-9 codes to the list of -covered diagnoses.-

To show you which new diagnosis codes will impact coverage for more than one lab test, we-ve compiled a chart that correlates the latest ICD-9 codes and the latest lab NCD update, both effective Oct. 1.

Use the Most Specific Code

The table shows many new codes that ICD-9 expanded from four-digit to five-digit codes:

- 238.7 expands to 238.71-238.79

- 277.3 expands to 277.30-277.39

- 288.0 expands to 288.00-288.09

- 995.2 expands to 995.20-995.29.

You-ll also find other new codes on the table that will impact coverage for more than one NCD.

Do this: Correct coding requires that you code as specifically as possible -- to the highest level provided by ICD-9. -Using the fifth digit when it is available is an important concept to follow,- says Karen Marsh, RN, MSN, president of Kare-Med Consulting in Jensen Beach, Fla.

Pitfall: Just because you have to code to the highest specificity doesn't mean you can fill in or assume any information that isn't in the patient's medical record. Code only what the ordering physician documents as the reason for the test.

Link to NCD

The latest NCD update tells you which codes Medicare will -- and won-t -- accept to show medical necessity for a lab test. Carriers won't accept any of the invalidated four-digit codes but will accept the new five-digit codes shown on the table.

Good news: The increased detail of the codes will help you to prove medical necessity for a procedure, says McCoy Rockefeller, CPC, coding specialist with the Medical College of Georgia in Atlanta. By staying current on your codes, you-ll be able to code more accurately, increase your chances of proving medical necessity and decrease your chance of a denial.

See for yourself: You-ll find the list of new ICD-9 codes at www.cms.hhs.gov/AcuteInpatientPPS/downloads/cms1488p.pdf. Skip to page 840, Table 6A, where the lists of new and revised diagnosis and procedure codes begin. You-ll find the latest NCD update in Change Request 5293 at www.cms.hhs.gov/transmittals/downloads/R1050CP.pdf.