Check NCDs for ICD-10-CM Diagnosis Code Updates

Surgery ModifiersChanges to ICD-10-CM Diagnosis Code mean NCD coding changes.

ICD-10-CM Diagnosis Code changes went into effect Oct. 1, as usual, and the Centers for Medicare & Medicaid Services (CMS) is updating National Coverage Determinations (NCDs) to reflect those changes.

NCDs Affected by Updates to ICD-10-CM Diagnosis Code

CMS notes the following NCD coding changes in Change Request (CR) 11491:

  • NCD 20.9 Artificial Hearts and Related Devices
    • Delete I48.1
    • Add I48.11 Longstanding persistent atrial fibrillation
    • Add I48.19 Other persistent atrial fibrillation
  • NCD 20.9.1 Ventricular Assist Devices
    • Delete I48.1
    • Add I48.11, I48.19
  • NCD 20.34 Percutaneous Left-Atrial Devices
    • Delete I48.1
    • Add I48.11, I48.19, I48.21 Permanent atrial fibrillation
  • NCD 110.4 Extracorporeal Photopheresis
    • Add J44.0 Chronic obstructive pulmonary disease with (acute) lower respiratory infection
  • NCD 110.23 Stem Cell Transplantation
    • Add Place of Service (POS) codes 19, 21, and 22
  • NCD 190.3 Cytogenetic Studies
    • Add C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] – per “contractor discretion”
  • NCD 190.11 Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management
    • Delete I48.1, I48.2
    • Add: I26.93, I26.94, I48.11, I48.19, I48.21, I80.241, I80.242, I80.243, I80.251, I80.252, I80.253, I82.451, I82.452, I82.453, I82.461, I82.462, I82.463, I82.551, I82.552, I82.553, I82.561, I82.562, I82.563
  • NCD 210.3 Colorectal Cancer Screening
    • Delete C18.9, D12.6
    • Add Z86.004 Personal history of in-situ neoplasm of other and unspecified digestive organs
    • Add CPT® 74263 as non-covered, omitted by error
  • NCD 260.9 Heart Transplants
    • Delete I48.1, I48.2
    • Add I48.11, I48.19, I48.21
Check Your Medicare Claims Last Quarter 2019

Although the changes to ICD-10-CM diagnosis code went into effect Oct. 1, the effective date of CR 11491 is April 1, 2020, and the implementation dates are Dec. 18, 2019, for local Medicare Administrative Contractor (MAC) edits and April 6, 2020, for SSM edits. “MACs will adjust any claims processed in error associated with CR 11491 that you bring to their attention,” CMS states in the transmittal, issued Nov. 1.

For More Information: