National Government Services, Inc. Medicare Monthly Review Part A and B
A Combined Part A and Part B Newsletter

MMR-2007- 09B, September 2007

National Government Services Medical Policy Update - Indiana (00630) and Kentucky (00660) - Revised Local Coverage Determination (LCD): Erythropoietin Analogues for Non-End Stage Renal Disease (Non-ESRD) Anemia (R8) – Effective Date: July 30, 2007

Please note: Although this policy is effective for claims submitted on or after July 30, 2007, the LCD was published after the effective date.

Source of Revision: CMS Coverage Decision Memo for Erythropoiesis Stimulating Agents (ESAs) for non-renal disease indications ( CAG-00383N) dated July 30, 2007 available at: https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=203 .

The “Indications and Limitations of Coverage and/or Medical Necessity” section was updated. Chemotherapy- or Radiation-Therapy Induced Anemia in Patients with Non-myeloid malignancies was deleted.

The “ICD-9 Codes that Support Medical Necessity” section was updated. The ICD-9-CM coding group entitled “Chemotherapy- or Radiation-Therapy Induced Anemia in Patients with Non-myeloid Malignancies” was removed and ICD-9-CM codes 284.8, 990, and E933.1 were deleted.

The “ CMS National Coverage Policy” section was updated to include this reference.

The “Documentation Guidelines” were updated with the removal of documentation requirements for “Chemotherapy-Induced or Radiation-Therapy Induced Anemia in Patients with Non-myeloid Malignancies.”

Please note: In March, 2007, the 7 Contractor Medical Directors and MPU associates thoroughly reviewed each existing legacy LCD and applied agreed-upon criteria to determine the final roster of National Government Services policies. During the March 21 – 23 meeting, the CMDs decided which policies to retain/consolidate as all- National Government Services LCDs and which policies to retire. Data were pulled (including edit effectiveness data) and criteria were applied to each policy in making the retention determinations. The preparation and review of the policies in March constitutes the annual review for every legacy LCD and fulfills requirements in Chapter 13, Section 13.4(C) of the Medicare Program Integrity Manual. References to legacy AdminaStar Federal were updated to National Government Services. The supplemental instructions article (SIA) associated with this local coverage determination (LCD) was similarly updated. No notice period required and none given.

National Government Services Medical Policy Update - Indiana (00630) and Kentucky (00660) - Revised Supplemental Instructions Article (SIA): Erythropoietin Analogues for Non-End Stage Renal Disease (Non-ESRD) Anemia – Effective Date: July 30, 2007

Please note: Although instructions in this coding guideline are effective for claims submitted on or after 07/30/2007, the article was published after the effective date.

Source of Revision: CMS Coverage Decision Memo for Erythropoiesis Stimulating Agents (ESAs) for non-renal disease indications ( CAG-00383N) dated July 30, 2007 available at: https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=203 .

The “ CMS National Coverage Policy” section was updated to include this reference.

Coding instructions for patients with anemia induced by chemotherapy and/or radiation therapy in patients with non-myeloid malignancies were removed.

he local coverage determination (LCD) associated with this supplemental instructions article (SIA) was similarly updated.