Corporate Compliance

Where to go to get your laboratory NCD information

Medicare Insider, December 30, 2008

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Editor's Note: Kimberly Anderwood Hoy, director of Medicare and compliance for HCPro, is the author of this week's "Note from the Instructor."

This week, CMS published the laboratory Medicare National Coverage Determinations Coding Policy Manual and Change Report, containing medical necessity edits for 23 common diagnostic laboratory tests. CMS published a transmittal earlier in December announcing these changes, and the policies also appear in the Internet-only Medicare National Coverage Determinations Manual (NCD Manual). However, the best reference is the Policy Manual and Change Report.

The Policy Manual and Change Report contains several additional sections not available in the NCD Manual. There is a section containing codes that are never covered for laboratory tests because they represent non-covered screening reasons for laboratory tests. When these diagnosis codes are the reason for performing a laboratory test, CMS has clarified that no Advanced Beneficiary Notice of Noncoverage is necessary to hold the patient responsible for the test. There are also general coding instructions and coding instructions for each edit, which are not included in the policies for the individual tests and only appear in the Policy Manual and Change Report.

The Policy Manual and Change Report typically appears on its own Web site. You can access the January 2009 version at www.cms.hhs.gov/CoverageGenInfo/Downloads/manual200901.pdf. Prior versions of the manual are available at www.cms.hhs.gov/CoverageGenInfo/04_LabNCDs.asp.




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