September 17, 2013

New ID Number for ICD-10 Updates to LCDs—but No New Coverage Policies, clarifies CMS

By Janis Oppelt

April 10, 2014, is the “no-later-than” date by which all Medicare contractors must publish on the Medicare coverage database (MCD) their ICD-10 local coverage determinations (LCDs) and associated ICD-10 articles.

That’s the official word from the Centers for Medicare & Medicaid Services (CMS) in transmittal and MM8348 (issued on Sept. 6, 2013). According to CMS, this deadline will allow providers sufficient time to make system-specific billing changes, and there’s other good news.

All LCDs and articles will receive a new identification (ID) number. For example, LCD ID 1234 might become LCD ID 4567. Even though there will be new ID numbers CMS states that it does not consider these to be new policies. Instead, it considers this update to be a coding revision that does not change the intent of coverage and/or non-coverage within an LCD.

Therefore, if a Medicare administrative contractor (MAC) only translates ICD-9 codes to the appropriate ICD-10 code, the policy does not need to be vetted through its Carrier Advisory Committee or be sent through the public comment and notice process. However, if a MAC decides to revise more than just the ICD-10 code(s), CMS directs them to follow the normal LCD-development process outlined in Chapter 13 of the Medicare Program Integrity Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/pim83c13.pdf on the CMS website.

LCDs and articles that do not contain ICD-10 information must be published on the MCD no later than Sept. 4, 2014.

Information Source: For the above announcement, go to http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1293OTN.pdf.

Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.