Health Information Management

News: CMS releases local coverage determinations

CDI Strategies, September 26, 2013

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CMS has been releasing ICD-10 National Coverage Determination (NCD) “omnibus” transmittals since September 2012, which gives providers some information about CMS’ coverage policies moving forward. NCDs are only part of the picture. On September 6, CMS released Transmittal R1293OTN and MLN Matters® MM8348 setting April 10, 2014, as the deadline for all Local Coverage Determinations (LCDs) and related articles to be published in the Medicare Coverage Database.

Medicare Administrative Contractor’s (MACs) may decide to simply translate ICD-9 codes to ICD-10 and update the LCD with that new information. However, MACs can also revise more than just the ICD-10 code(s), so someone within each organization will need to compare the LCDs to determine whether they contain code updates or coverage changes.

An NCD is a nationwide determination of whether Medicare will pay for an item or service. NCDs apply in all Medicare jurisdictions. Fiscal Intermediaries (FI), carriers, and MACs develop and/or adopt LCDs when CMS has not issued an NCD or when the NCD needs to be further defined. LCDs are applicable only to the specific local carrier, FI, or MAC. They do not apply nationwide. So the policy in one region may differ from coverage policy in a different region.

A local policy may consist of two separate, though closely related, documents: the LCD and an associated article. The LCD only contains reasonable and necessary language. The article includes any additional language or guidance a Medicare contractor wants to add.

CMS issued Transmittal R96MSP directing its contractors to fully implement all ICD-10-related system changes no later than October 1, 2013, to allow for end-to-end testing.

Editor’s Note: This article originally published on the ICD-10 Trainer Blog.

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