MIR-2006-12A, December 2006

LCD and Article Revisions for December 2006

Reticulocyte Counts – L2165
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 5 - 7:

5. 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).
6. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
7. 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 Diagnosis Codes That Support Medical Necessity” section, replaced the terminated code 284.0 with the following:

Also, added the following new codes:

Also, under this section, the code descriptor for 285.29 has been updated.

Related Article Revisions:
Under the “Coding Guidelines” section, added numbers 4 and 5:

4. The ICD-9-CM code 284.0 was deleted effective September 30, 2006 and the replacement codes 284.01 and 284.09 are effective for services performed on or after October 1, 2006.
5. The new ICD-9-CM codes 284.1 and 284.2 are effective for services performed on or after October 1, 2006.

Routine Foot Care – L648
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 “Indications and Limitations of Coverage and/or Medical Necessity” section added the following as the first paragraph:

The Medicare Program generally does not cover routine foot care. However, this determination outlines specific conditions which may be coverable.

This paragraph was added to the “LCD Description”: section of the related article.

Under the “Indications” section, updated the first paragraph from:

Medicare payment may be made for routine foot care when the patient has a systemic disease of sufficient severity that performance of such services by a nonprofessional person would put the patient at risk (for example, a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization).

To show as number 1:

1. Medicare payment may be made for routine foot care when the patient has a systemic disease, such as metabolic, neurologic or peripheral vascular disease, of sufficient severity that performance of such services by a nonprofessional person would put the patient at risk (for example, a systemic condition that has resulted in severe circulatory embarrassment or areas of desensitization in the patient’s legs or feet).

Also, under this section, added numbers 2 - 4

2. Treatment of warts on the foot is covered to the same extent as services provided for the treatment of warts located elsewhere on the body.
3. Services normally considered routine may be covered if they are performed as a necessary and integral part of otherwise covered services, such as diagnosis and treatment of ulcers, wounds, or infections.
4. Treatment of mycotic nails may be covered under the exceptions to the routine foot care exclusion. The class findings outlined below, or the presence of qualifying systemic illnesses causing a peripheral neuropathy, must be present. (Treatment of mycotic nails for patients without systemic illnesses may also be covered and are defined in a separate Local Coverage Determination [LCD] for Debridement of Mycotic Nails.)

The second paragraph is now number 5.

Under the Class B Findings section, updated the second bullet from:

• Advanced trophic changes as evidenced by three of the following:

To show the following:

• Advanced trophic changes as evidenced by any three of the following:

Under the Class C Findings section, added the following Note:

Note: Benefits for routine foot care are also available for patients with peripheral neuropathy involving the feet, but without the vascular impairment outlined in Class B findings. The neuropathy should be of such severity that care by a non-professional person would put the patient at risk. If the patient has evidence of diabetes with peripheral neuropathy, but no vascular impairment, the use of class findings modifiers is not necessary. This condition would be represented by ICD-9-CM codes 250.60 - 250.63 or 357.2.

Under the “Limitations” section, updated number 1 from:

1. When the patient’s condition is designated by an ICD-9-CM diagnosis code with an asterisk(*) (see ICD-9-CM Codes That Support Medical Necessity), routine procedures are reimbursable only if the patient is under the active care of a doctor of medicine or osteopathy (MD or DO) for such conditions.

To show the following:

1. When the patient’s condition is designated by an ICD-9-CM diagnosis code with an asterisk(*) (see ICD-9-CM Codes That Support Medical Necessity section), routine foot care procedures are coverable only if the patient is under the active care of a doctor of medicine or osteopathy (MD or DO) or qualified non-physician practitioner for the treatment and/or evaluation of the complicating disease process during the six (6)-month period prior to the rendition of the routine-type service or if the patient had come under a physician’s care shortly after the services were furnished.

Under the “ICD-9-CM Codes That Support Medical Necessity” section, replaced the deleted code 277.3 with the following codes:

Under the section for Peripheral neuropathies involving the feet, associated with: updated the ** note from:

** For treatment of Mycotic Nails, this diagnosis must be reported as primary, with the diagnosis representing the patient’s systemic condition reported as the secondary ICD-9-CM code. Refer to the “Indications and Limitations” section of this LCD for additional information.

To show the following:

 ** For treatment of Mycotic Nails, the diagnosis code 110.1 must be reported as primary, with the diagnosis representing the patient’s systemic condition reported as the secondary ICD-9-CM code. Refer to the “Indications and Limitations” section of this LCD for additional information.

Related Article Revisions:
Under the “Coding Guidelines” section, added number 7:

7. The ICD-9-CM code 277.3 has been terminated effective September 30, 2006 and the replacement codes 277.30 and 277.39 are effective for services performed on or after October 1, 2006.

Serum Magnesium – L703
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, replaced the deleted code 995.2 with the following codes:

Also, the following ICD-9-CM codes have new descriptors: 255.10, 403.00, 403.01, 403.10, 403.11, 403.90, 404.00 - 404.03, 404.10 - 404.12, 404.90, and 780.31

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

8. The ICD-9-CM code 995.2 has been deleted effective September 30, 2006 and the replacement codes 995.20, 995.27, and 995.29 are effective for services performed on or after October 1, 2006.

Urinalysis – L678
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, replaced the deleted codes 277.3 and 608.20 with the following codes:

The following are new ICD-9-CM codes that have been inserted into the range of codes for 788.0 - 788.9:

Also, the following ICD-9-CM codes have new descriptors: 406.00, 403.01, 403.10, 403.11, 403.90, 403.91, 404.00 - 404.03, 404.10 - 404.13, 404.90 - 404.93, 600.00, 600.01, 600.20, 600.21, 600.90, 900.91, and 790.93.

Related Article Revisions:
Under the “Coding Guidelines” section, added numbers 8 and 9:

8. The ICD-9-CM codes 277.3 and 608.2 have been deleted effective September 30, 2006 and the replacement codes 277.30, 277.31, and 608.20 - 608.24 are effective for services performed on or after October 1, 2006.
9. The new ICD-9-CM codes 788.64 and 788.65 are effective for services performed on or after October 1, 2006.

Zoledronic Acid – L690
LCD Revisions:
Under the “CMS National Coverage Policy” section, added numbers 5 - 7:

5. 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).
6. Change Request (CR) 5244, dated September 1, 2006. October 2006 Outpatient Prospective Payment System (OPPS) Outpatient Code Editor (OCE) Specifications Version 7.3.
7. 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 codes 995.2 with the following code:

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

8. The ICD-9-CM code 995.2 has been deleted effective September 30, 2006, and the replacement code 995.29 is effective for services performed on or after October 1, 2006.

© All current procedural terminology (CPT) codes and descriptors copyrighted by the American Medical Association.