Pathology/Lab Coding Alert

Your ‘covered diagnoses’ lists will accommodate new code set.

You know that you’ll have to start using ICD-10 on Oct. 1, 2014, but have you ever thought about how that will mesh with National Coverage Determinations (NCDs) that list ICD-9 codes to show testing medical necessity? 

The time has come ensure timely replacement of applicable ICD-9 codes with corresponding ICD-10 codes in NCDs, according to recent CMS communications.

Read the General Plan

CMS recently instructed contractors in to start the process of creating and updating NCDs that contain ICD-9 codes. CMS said that carriers should assign comparable ICD-10 codes to them by the ICD-10 implementation date of Oct. 1, 2014. The directive was part of MLN Matters article MM8109.

This should help practices immeasurably, since inclusion of applicable ICD-10 codes on NCDs could at least offer a window into how Medicare payers will view each new diagnosis code and which codes it deems payable for particular services.

For instance: The ordering diagnosis for prostate cancer screenings will change from V76.44 (Screening for malignant neoplasms of prostate) to Z12.5 (Encounter for screening for malignant neoplasm of prostate) on Oct. 1, 2014.

To read the complete MLN Matters article associated with CR 8109, visit www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8109.pdf.

Check Out Lab NCD Instruction

In another memo, CR 8202, CMS gives specific instruction about updating laboratory NCDs to accommodate ICD-10. The implementation date is July 1, 2013, “prior to the effective date [Oct 1, 2014] in order to be prepared to meet the timeline to implement the new ICD-10 diagnosis codes,” according to the memo. You can read the instruction at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1174OTN.pdf .

Back story: CMS maintains a list of NCDs for 23 clinical laboratory tests from alpha-fetoprotein to urine culture, with each NCD listing possibly hundreds of ICD-9 codes that indicate medical necessity for the test. CMS updates the lab NCDs quarterly, and you can access the most recent file at

www.cms.gov/Medicare/Coverage/CoverageGenInfo/downloads/manual201301.pdf#14.