To comply with regulations, the current ICD-9 Code(s) (diagnosis, symptoms) must be supplied by the physician or the facility staff when the order is given to the lab. CMS (Center for Medicare and Medicaid Services) has developed 23 NCD's (National Coverage Determinations) for commonly ordered lab tests. Medicare will deny payment to the lab if the ICD-9 code(s) given do not meet Medical Necessity Guidelines.
Please refer to the NCD ICD-9 list when coding the patient's order. Symptoms should match the code you are submitting. Please note: Exception-CBC. Most diagnosis will meet Medical Necessity Guidelines for CBC's. Therefore the codes are too many to list. CMS has listed the diagnosis codes that DO NOT meet the Medical Necessity Guidelines. DO NOT use the codes listed for CBC. All other test codes listed are qualifying codes.
The Centers for Medicare and Medicaid Services (CMS) announced a mechanism for keeping the NCD code list current. CMS updates the NCD code list quarterly as necessary to incorporate new codes, correct ministerial errors and incorporate reconsideration of the NCDs that alter covered indications. The quarterly updates are published in the NCD Coding Policy Manual. You can access and download the current and previous coding manuals by visiting the CMS.gov.