MIR-2006-11A, November 2006

LCD and Article Revisions for November 2006

Debridement Services – L637
LCD Revisions:
Under the “CMS National Coverage Policy” section, added number 6:

6. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Under the “ICD-9-CM Codes That Support Medical Necessity” section, under both CPT code sections, removed the following code:

Also removed the ICD-9-CM codes 997.60, 997.62, and 997.69 from the section for CPT codes 11000 and 11001. Under the section for CPT codes 11040 - 11044, removed the following codes to coordinate with Empire Part B: 681.00, 681.01, 681.10, 682.0 - 682.8, 906.5 - 906.8, 910.1, 910.5, 910.9, 911.1, 911.5, 911.9, 912.1, 921.9, 913.1, 913.5, 913.9, 914.1, 914.5, 914.9, 915.1, 915.5, 915.9, 916.1, 916.5, 916.9, 917.1, 917.5, and 998.51. Also, under this section, added the following code:

Article Revisions:
Under the “Coding Guidelines” section, added numbers12 - 14:

12. The ICD-9-CM code 996.62 is effective for services performed on or after September 30, 2006.
13. The following ICD-9-CM codes have been removed effective for services performed on or after September 30, 2006: 681.00, 681.01, 681.10, 682.0 - 682.8, 906.5 - 906.8, 910.1, 910.5, 910.9, 911.1, 911.5, 911.9, 912.1, 921.9, 913.1, 913.5, 913.9, 914.1, 914.5, 914.9, 915.1, 915.5, 915.9, 916.1, 916.5, 916.9, 917.1, 917.5, 997.61, and 998.51.
14. A claim submitted without a valid ICD-9-CM diagnosis code will be returned as an incomplete claim under section 1833(e) of the Social Security Act.

Erythropoietin (Epoetin Alpha, EPO) for Non-ESRD Use (related article only) – A20330  

Article Revisions:
Under the “Coding Guidelines” section, added number 8:

8. The ICD-9-CM codes 159.0, 159.1, 181 and 183.3 have been added to coordinate with Empire Part B and are effective for services performed on or after October 1, 2003.

Incision and Drainage Services – L694
LCD Revisions:
Under the “Indications” section, updated the first paragraph from:

Incision and drainage services are covered for treating abscesses (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia), hematomas, seromas, cysts or other pathologic fluid collections as well as for postoperative wound infections.

To show the following:
Incision and drainage services are covered for treating abscesses (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, postoperative wound infections, or paronychia). Incision and drainage of hematomas, seromas, cysts, or other pathologic fluid collections are covered when medically necessary due to pain, inflammation, or infection.

Under the “Limitations” section, updated number 4 from:

4. Incision and drainage services are not payable for treatment of blisters unless there is superinfection with pus abscess formation.

To show the following:

4. Use of incision and drainage of abscess codes (10060, 10061) is limited to lesions with documented abscess and/or pus collection. Use of these codes is not appropriate for treatment of blisters, cysts (including sebaceous cyst), or other fluid collections without the documented presence of discrete abscess, pus collection, pain, infection or inflammation.

Under the “Bill Type Codes” section, added 85X for Critical Access Hospitals (CAH).

This section was also updated in the related article.
Under the “ICD-9-CM Codes That Support Medical Necessity” section, removed the following codes to coordinate with Empire Part B:

372.75, 373.13, 374.84, 375.00, 375.30, 375.43, 380.10, 527.3, 528.3, 528.4, 566, 597.0, 608.4, 610.0, 610.8, 616.2 - 616.4, 683, 703.8, 906.0 - 906.4, 920, 922.0 - 922.9, 923.00 - 923.9, 924.00 - 924.9, 925.1, 925.2, 926.0 - 926.9, 927.00 - 927.9, 928.00 - 928.9, 929.0, 929.9, 996.77, and 996.78.

Also under this section, added the following codes to coordinate with Empire Part B:
686.00, 686.01, 686.09, 686.1, 917.9, 958.3, 996.62.

Under the “Documentation Requirements” section, updated number 5 from:

5. Since the majority of hematomas do not require incision and drainage or aspiration, and since this procedure can actually increase the risk of infection, providers reporting these services must document the size, location, and quantity of blood or serosanguineous fluid drained, as well as the medical necessity of the procedure (e.g., severe pain, failure to resolve with conservative measures).

To show the following:

5. Since the majority of hematomas, seromas, and cysts do not require incision and drainage or aspiration, and since this procedure can actually increase the risk of infection, providers reporting these services must document the size, location, and quantity of blood, material, or serosanguineous fluid drained, as well as the medical necessity of the procedure (e.g., severe pain or infection and failure to resolve with conservative measures).

Under the “Sources of Information and Basis for Decisions” section, added numbers 7 and 8:

7. Odom, Richard B., M.D., James, William D., M.D. and Berger, Timothy G., M.D. Andrews’ Diseases of the Skin: Clinical Dermatology (9th ed.), 862-863. Saunders (9th ed.), 862-863. Saunders, An Imprint of Elsvier.
8. Freedberg, Irwin M., M.D. (editor), Eisen, Arthur Z., M.D. (editor), Wolff, Klaus, M.D., DSc (Hon) (editor), Austen, K. Frank, M.D. (editor), Goldsmith, Lowell A., M.D. (editor), Katz, Stephen I., M.D., PhD (editor), Fitzpatrick, Thomas B., M.D., PhD, DSc (Hon) (editor). Fitzpatrick’s Dermatology in General Medicine (5th ed.) Vol. 1, p. 884. Mcgraw-Hill.

 Article Revisions:  

Under the“Coding Guidelines” section, added numbers7 and 8:

7. The following ICD-9-CM codes have been removed to coordinate with Empire Part B, effective for services performed on or after October 7, 2006:
8. 372.75, 373.13, 374.84, 375.00, 375.30, 375.43, 380.10, 527.3, 528.3, 528.4, 566, 597.0, 608.4, 610.0, 610.8, 616.2 - 616.4, 683, 703.8, 906.0 - 906.4, 920, 922.0 - 922.9, 923.00 - 923.9, 924.00 - 924.9, 925.1, 925.2, 926.0 - 926.9, 927.00 - 927.9, 928.00 - 928.9, 929.0, 929.9, 996.77, and 996.78.
9. The following ICD-9-CM codes have been added to coordinate with Empire Part B, effective for services performed on or after October 7, 2006: 686.00, 686.01, 686.09, 686.1, 917.9, 958.3, and 996.62.

Pap Smear – L557
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 11 – 13:

11. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
12. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
13. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.
Under the “ICD-9-CM Codes That Support Medical Necessity” section, replaced the deleted code 616.8 with the following codes:

Also, under this section, added the following new code:

Article Revisions:
Under the “Coding Guidelines” section, added number 15:

15. The ICD-9-CM code 616.8 was deleted effective September 30, 2006, and the replacement codes 616.81 and 616.89 are effective for services performed on or after October 1, 2006.

Potassium (Serum) Levels – L586
LCD Revisions:
Under the “CMS National Coverage Policy” section added numbers 7 - 9:

7. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
8. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
9. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, replaced the deleted code 995.2 with the following codes:

Also under this section, there are descriptor changes for the following codes: 255.10, 403.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00-404.03, 404.10-404.13, 404.90-404.93.

Article Revisions:
Under the “Coding Guidelines” section, added numbers 9 and 10:

9. The ICD-9-CM code 995.2 was terminated effective September 30, 2006, and the replacement codes 995.20 - 995.23, 995.27 and 995.29 are effective for services performed on or after October 1, 2006.
10. The following ICD-9-CM descriptors have been updated effective October 1, 2006: 255.10, 403.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00-404.03, 404.10-404.13, 404.90-404.93.

Pulmonary Function Testing – L622
Under the “CMS National Coverage Policy” section added numbers 7 - 9:

7. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
   
8. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
   
9. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, replaced the terminated code 519.1 with the following codes:

Also, under this section, added the following new code:

Article Revisions:
Under the “Coding Guidelines” section, added numbers 11 and 12:

11. The new ICD-9-CM code 518.7 is effective for services performed on or after October 1, 2006.
    
12. The ICD-9-CM code 519.1 has been terminated effective September 30, 2006. The replacement codes 519.11 and 515.19 are effective for services performed on or after October 1, 2006.

Pulse Oximetry – L2205
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 9 - 11:

9. Change Request (CR) 5142, dated June 23, 2006. Medicare Contractor Annual Update of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).
   
10. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
    
11. Change Request (CR) 5256, dated September 18, 2006. October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0.

This section was also updated in the related article.  

Under the “ICD-9-CM Codes That Support Medical Necessity” section, added the new code 518.7:

Also under this section, updated the code descriptors for 404.91 and 404.93.

Article Revisions:
Under the “Coding Guidelines” section, added number 17:

17. The new ICD-9-CM code 518.7 is effective for services performed on or after October 1, 2006.