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Medical Coding News Archives

Lab Coverage Changes Effective July 1

July 14, 2009:

Changes to the covered diagnosis codes for laboratory services are effective for services furnished on or after July 1, 2009.

The revised national coverage determinations (NCD) for clinical diagnostic laboratory services were incorporated into Medicare claims systems to ensure that laboratory claims that are subject to one of the 23 NCDs are processed uniformly. The laboratory NCD edit software is updated quarterly to reflect coding updates and other substantive changes to NCDs.

The Centers for Medicare and Medicaid Services updates the NCD code list to include new codes, reflect the results of coding analysis, correct errors, and include altered coverage indications resulting from reconsideration of the NCDs. The coding guidelines associated with these NCDs and the quarterly updates are published in the NCD Coding Policy Manual. Current and previous coding manuals can be found at this site: http://www.cms.hhs.gov/CoverageGenInfo/04_LabNCDs.asp.

The changes to the laboratory edit module NCD code lists for July 2009 include:

For the prothrombin time (PT) (85610), gamma glutamyl transferase (82977), and serum iron studies (82728, 83540, 83550, 84466) furnished on or after July 1, 2009, Medicare will cover the following ICD-9-CM codes:

200.30–200.38 Marginal zone lymphoma
200.40–200.48 Mantle cell lymphoma
200.50–200.58 Primary central nervous system lymphoma
200.60–200.68 Anaplastic large cell lymphoma
200.70–200.78 Large cell lymphoma
202.70–202.78 Peripheral T-cell lymphoma

Also added to the list of covered codes for the PT is code 440.4 Chronic total occlusion of artery of the extremities. Code 440.4 was also added to the list of ICD-9-CM codes covered by Medicare for lipid testing (80061, 82465, 83700, 83701, 83704, 83718, 83721, 84478).

The official instruction (CR6481) issued by Medicare may be found at http://www.cms.hhs.gov/Transmittals/downloads/R1735CP.pdf on the CMS website.

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical/Technical Editor


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