Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers and/or fiscal intermediaries (FIs) for clinical diagnostic laboratory services.

Provider Action Needed

Impact to You
This article is based on Change Request (CR) 4161, which announces the implementation of changes to the list of codes associated with the 23 negotiated laboratory NCDs.

What You Need to Know
These changes to the list of codes are a result of revised NCD and coding analysis decisions developed under the procedures for maintenance of codes in the negotiated NCDs. They are necessary for the correct processing of claims using the most current negotiated lab NCDs and code lists.

What You Need to Do
See the Background section of this article for further details regarding these changes.

Background
The National Coverage Determinations (NCDs) for clinical diagnostic laboratory services were developed by the laboratory negotiated rulemaking committee and published in the Federal Register as a final rule on November 23, 2001. (See below for links to the Final Rule.)

The Centers for Medicare & Medicaid Services (CMS) funded the development of software (laboratory edit module) to be incorporated in the shared systems so that laboratory claims subject to one of the 23 NCDs are processed uniformly throughout the nation effective January 1, 2003. (See below for more information contained in the Medicare Claims Processing Manual.)

Note: The laboratory edit module for the NCDs is updated quarterly as necessary to reflect coding updates and substantive changes to the NCDs developed through the NCD process.

Change Request (CR) 4161 announces the changes that will be included in the January 2006 release of the edit module for clinical diagnostic laboratory services. Changes are being made to the NCD code lists (as described below) to accommodate changes to the list of codes that have been made through the NCD and/or coding analysis process as explained in the final Federal Register notice. (See reference below.)

Code Changes  
CR 4161 announces the following changes:

• ICD-9-CM code V76.44 (special screening for malignant neoplasms, prostate) will be removed from the list of ICD-9-CM codes not covered by Medicare. This list of codes affects all 23 negotiated laboratory NCDs.
• ICD-9-CM code V76.44 (special screening for malignant neoplasms, prostate) will be added to the list of ICD-9-CM codes that do not support Medical Necessity in the Blood Counts NCD.
• ICD-9-CM codes 158.8 (Malignant neoplasms, specific parts of peritoneum) and 158.9 (Malignant neoplasms, peritoneum, unspecified) will be added to the list of ICD-9-CM codes covered by Medicare in the Tumor Antigen by Immunoassay CA 125 NCD.

Decision memoranda explaining these changes can be found by going to http://cms.hhs.gov/coverage on the CMS Web site and clicking on the National Coverage Analysis in the Coverage Database section of the Web page. These changes become effective for services furnished on or after January 1, 2006.

Implementation
The implementation date for the instruction is January 3, 2006.

Additional Information
For complete details, please see the official instruction issued to your carrier/intermediary regarding this change. That instruction may be viewed at http://www.cms.hhs.gov/Transmittals/ on the CMS Web site. From that Web page, look for CR4161 in the CR NUM column on the right and click on the file for that CR.

If you have any questions, please contact your carrier/intermediary at their toll-free number, which may be found at http://www.cms.hhs.gov/MedlearnProducts/downloads/CallCenterTollNumDirectory.pdf on the CMS Web site.

Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.

For more information, visit the Medlearn Matters Web page at: http://www.cms.hhs.gov/MedlearnMattersArticles/.

Pub. 100-4, Transmittal# 758, CR# 4161
Medlearn Matters Number: MM4161

Related CR Release Date: November 18, 2005

Effective Date: January 1, 2006
Implementation Date: January 3, 2006

Posted: 12/02/2005

CPT codes, descriptions, and other data only are copyright 2005 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply.