Wiki New Medicare LCD for Colonoscopy

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rheaton

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Has anyone had any feedback from their physicians regarding the new Medicare LCD put out for colonoscopies? The LCD does not have Iron De as a covered indication! This just went into effect 3/21/21. It is a real concern because iron deficiency is a number one symptom of Colon Ca. Does anyone know who I would contact to see if this was an oversight or to have it added?
 
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The latest revision the the Colonoscopy LCD was 10/1/2020 for my area. I does include both D50.0 and D50.9. We have no draft/proposed changes that I can see.
 
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I am struggling with the same issue, I am in Florida and we use first coast service options, they revised the LCD effective 3/21/2021 and have removed all of the abdominal pain codes as being covered in addition to removing D50.9, has anyone else came across this yet? I am considering using R19.8 as replacement to the more specific codes, and am wondering if anyone has any feed back in relation to this?
 
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We are having an issue with this new LCD in Colorado as well. My provider does colonoscopies as a screening and uses Z12.11, which have always been fine, but it's not on the new list of codes for medical necessity. Does anyone have any insight on how to best handle these? Thanks
 
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pJohnson15 said:
We are having an issue with this new LCD in Colorado as well. My provider does colonoscopies as a screening and uses Z12.11, which have always been fine, but it's not on the new list of codes for medical necessity. Does anyone have any insight on how to best handle these? Thanks
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If you are billing the screening using the HCPCS code G0121 or G0105 the Z12.11 is covered. It is when it turns diagnostic/therapeutic (45378,45380 etc) that you will need a covered DX and Z12.11, Z86.010, Z80.0 (none of the Z codes) are on the LCD...at least for Oklahoma-Novitas.
 
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rheaton said:
Has anyone had any feedback from their physicians regarding the new Medicare LCD put out for colonoscopies? The LCD does not have Iron De as a covered indication! This just went into effect 3/21/21. It is a real concern because iron deficiency is a number one symptom of Colon Ca. Does anyone know who I would contact to see if this was an oversight or to have it added?
Click to expand...
In Oklahoma-Novitas the D50.9 is not on the LCD but being more specific such as D50.0 (Iron De due to chronic blood loss) is on the LCD, but it is the only iron deficiency code that is on the policy. I agree this new LCD is quite troublesome because the abdominal pain DX codes are not covered as well as many others our providers use.
 
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kboyd22 said:
In Oklahoma-Novitas the D50.9 is not on the LCD but being more specific such as D50.0 (Iron De due to chronic blood loss) is on the LCD, but it is the only iron deficiency code that is on the policy. I agree this new LCD is quite troublesome because the abdominal pain DX codes are not covered as well as many others our providers use.
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Heard today that Novitas has published a revision adding the D50.9 coding - along with others.
 
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I'm glad to see Novitas putting many of the deleted dx codes back into the LCD. I want to make sure I'm understanding this correctly. The ONLY thing that will indicate to medicare that this was a screening colonoscopy that turned diagnostic is the PT modifier, correct? Since Z12.11 can no longer be used on diagnostic scopes, I mean.
 
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You are correct. PT tells the insurance the colonoscopy started as a screening but turned into diagnostic.
If a Medicare patient comes in for a screening, whether it's an average risk (Z12.11) or High risk (personal or family history), we are to use the PT to indicate that to Medicare. Noridian Medicare has us list the Z codes first then the findings in box 21 (HCFA) BUT link the findings first then the Z code last in Box 24E on a HCFA, and use the PT modifier.
I wasn't sure what you meant by "Since Z12.11 can no longer be used on diagnostic scopes, I mean."
 
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Thanks so much for your response! In our software, the claim rejects as non-covered if I add Z12.11 anywhere on the claim. We use EPIC, but I suspect this particular edit has been added by the organization that designed/updates our software.
 
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rheaton said:
Has anyone had any feedback from their physicians regarding the new Medicare LCD put out for colonoscopies? The LCD does not have Iron De as a covered indication! This just went into effect 3/21/21. It is a real concern because iron deficiency is a number one symptom of Colon Ca. Does anyone know who I would contact to see if this was an oversight or to have it added?
Click to expand...
There was a revision to the LCD that was published on 6/10/2021 and they backdated it to 3/21/2021; They added the following ICD 10 codes to list that meets medical necessity: D50.9, D62, K57.30, R10.30, R10.31,R10.32,R10.33,R10.813,R10.814,R10.815,R10.817,R10.84,Z86.010
 
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