LAB NCD for 83036

edited May 2017 in Part B Archive
Hello,

Okay this is bizarre, "pre-diabetes" prior to 10.1.16 was coded as R73.09. As of 10.1.16 new code R73.03 is specific to pre-diabetes. The lab NCD manual did not include this new code as a covered indication... only R73.01, R73.02 and R73.09 are listed as covered.

Doesn't make sense to me. I think CMS made a mistake and I'm not sure what to do about it.

Erica

Comments

  • edited May 2017
    Well I found an e-mail address and sent this to CMS; we'll see if they actually respond.

    From: Erica Schwalm
    Sent: Thursday, October 20, 2016 3:57 PM
    To: 'CAG_Lab_NCD@cms.hhs.gov'
    Subject: Question regarding CPT 83036
    Importance: High

    Dear CMS,

    "Pre-diabetes", prior to 10.1.16, was coded as R73.09. As of 10.1.16, new code R73.03 is specific to pre-diabetes. The lab NCD manual did not include this new code as a covered indication... only R73.01, R73.02 and R73.09 are listed as covered.

    Is this in an error? Or are you saying “other abnormal glucose NOS” is covered but pre-diabetes is not? I’m confused. Please clarify.

    Sincerely,

    Erica Schwalm
    Coding & Reimbursement Coordinator
    Convergent Solutions, Inc.
    (413) 509-1000 x121


  • From CMS Website:  Note that their will be no mass adjustment, you must bring to the contractors attention.


    Lab NCDs - ICD-10
    Transition from ICD-9-CM to ICD-10-CM for the Lab NCDsBased on the 2010 Affordable Care Act (2010), the ICD-10-CM codeset is used (instead of ICD-9-CM) by all covered entities to encode diagnoses in HIPAA-regulated transactions, such as Medicare billing claims for diagnostic clinical laboratory services.  Following the provisions of the Preserving Access to Medicare Act (2014), the effective date of this transition from ICD-9-CM to ICD-10-CM will be no earlier than October 1, 2015.  For more details about the implementation of ICD-10-CM coding, please see the website www.cms.gov/ICD10 .
    In consultation with its contractors and after review to achieve maximal clinical equivalence of ICD-9-CM and ICD-10-CM codes, CMS has used the General Equivalence Mappings (GEMs) to convert ICD-9-CM codes to ICD-10-CM codes.  The GEMs have been posted by CMS for 2015 at www.cms.gov/ICD10.  Please note that CMS followed the Partial Code Freeze for ICD-9-CM and ICD-10 updates from October 1, 2011 through September 30, 2016. Information about the Partial Code Freeze is available at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf. **
    Please note that due to this being the first regular ICD-10 code update since the partial code freeze October 1, 2011, (there were limited new codes introduced in fiscal years 2012, 2013, 2014, and 2015), and the voluminous number of new codes involved, the Medicare shared systems will split implementation of the new codes over the January 2017 and April 2017 quarterly updates. While the implementation dates will be in January and April, the effective dates of the new codes will still be October 1, 2016. All deleted codes will not be valid for payment after September 30, 2016. Contractors will be instructed to adjust claims brought to their attention. Pat Schmitter CPC, CPC-I Sr Healthcare Consultant Approved ICD-10-CM Trainer AAPC and AHIMA

    On Thursday, October 20, 2016 4:07 PM, Erica Schwalm wrote:


    Well I found an e-mail address and sent this to CMS; we'll see if they actually respond. 

    From: Erica Schwalm
    Sent: Thursday, October 20, 2016 3:57 PM
    To: 'CAG_Lab_NCD@cms.hhs.gov'
    Subject: Question regarding CPT 83036
    Importance: High

  • edited May 2017
    So that means we need to deal with 3-6 months of denials and then bring them to their attention to reprocess? That seems ridiculous doesn't it?


    From: Pat Schmitter CPC CPC-I [mailto:pbnjna@sbcglobal.net]
    Sent: Sunday, October 23, 2016 11:15 AM
    To: Multiple recipients of list PARTB-L
    Subject: Re: [partb-l] LAB NCD for 83036

    From CMS Website: Note that their will be no mass adjustment, you must bring to the contractors attention.

    Lab NCDs - ICD-10
    Transition from ICD-9-CM to ICD-10-CM for the Lab NCDs
    Based on the 2010 Affordable Care Act (2010), the ICD-10-CM codeset is used (instead of ICD-9-CM) by all covered entities to encode diagnoses in HIPAA-regulated transactions, such as Medicare billing claims for diagnostic clinical laboratory services. Following the provisions of the Preserving Access to Medicare Act (2014), the effective date of this transition from ICD-9-CM to ICD-10-CM will be no earlier than October 1, 2015. For more details about the implementation of ICD-10-CM coding, please see the website www.cms.gov/ICD10 .

    In consultation with its contractors and after review to achieve maximal clinical equivalence of ICD-9-CM and ICD-10-CM codes, CMS has used the General Equivalence Mappings (GEMs) to convert ICD-9-CM codes to ICD-10-CM codes. The GEMs have been posted by CMS for 2015 at www.cms.gov/ICD10.
    Please note that CMS followed the Partial Code Freeze for ICD-9-CM and ICD-10 updates from October 1, 2011 through September 30, 2016. Information about the Partial Code Freeze is available at http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf. **

    Please note that due to this being the first regular ICD-10 code update since the partial code freeze October 1, 2011, (there were limited new codes introduced in fiscal years 2012, 2013, 2014, and 2015), and the voluminous number of new codes involved, the Medicare shared systems will split implementation of the new codes over the January 2017 and April 2017 quarterly updates. While the implementation dates will be in January and April, the effective dates of the new codes will still be October 1, 2016. All deleted codes will not be valid for payment after September 30, 2016. Contractors will be instructed to adjust claims brought to their attention.

    Pat Schmitter CPC, CPC-I Sr Healthcare Consultant Approved ICD-10-CM Trainer AAPC and AHIMA

    On Thursday, October 20, 2016 4:07 PM, Erica Schwalm wrote:

    Well I found an e-mail address and sent this to CMS; we'll see if they actually respond.

  • This doesn't even sound like they are addressing the issue with current changes; did I miss that part?
    Kimberly A.Poore

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