National Coverage Determination 2007 - 2008

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.

This manual has been compiled from the Medicare website to assist you when coding laboratory requisitions. The listing is in alphabetical order by test, and Symptoms / Diagnosis. List the chief symptom in the first ICD-9 box on the requisition followed by existing diagnosis.

Additional tests may be added to this list of NCD tests, and diagnosis may be added to those that Medicare accepts to justify medical necessity at any time. For the most current information please refer to the Medicare website at: www.medicarenhic.com