On July 27 CMS issued Transmittal 1875 (CR 10184), which updates the ICD-10 codes for several National Coverage Determinations (NCDs).  This is the latest in a series of transmittals that identify the diagnosis and procedure codes for services covered by NCDs.  These transmittals do not represent policy changes, just corrections and updates to the current code list for each NCD. 

CMS is not requiring contractors to search for and reprocess claims affected by this latest transmittal.  However, contractors are advised to adjust any claims that are brought to their attention.

NCD 220.6.17 PET for Solid Tumors

The following covered codes are added effective October 1, 2016:

C49.A1

Gastrointestinal stromal tumor of esophagus)

C49.A2   

Gastrointestinal stromal tumor of stomach

C49.A3

Gastrointestinal stromal tumor of small intestine

C49.A4

Gastrointestinal stromal tumor of large intestine

C49.A5

Gastrointestinal stromal tumor of rectum

C49.A9

Gastrointestinal stromal tumor of other sites

R91.8 

Other nonspecific abnormal finding of lung field

Note that code R91.8 will apply only to claims for initial treatment strategy.  Claims for subsequent treatment strategy are covered only if submitted with a cancer diagnosis code.

The following codes are deleted from the covered list effective October 1, 2015:

C79.51

Secondary malignant neoplasm of bone

C79.52 

Secondary malignant neoplasm of bone marrow

C80.0  

Disseminated malignant neoplasm, unspecified

C80.1    

Malignant (primary) neoplasm, unspecified

Although the code for primary of unknown site (C80.1) is no longer covered, the codes for secondary malignant neoplasms are still on the covered list.  Therefore, a claim submitted with the code for the known secondary site and code C80.1 for unknown primary should still be covered.

 

NCD 220.6.20 PET Beta Amyloid in Dementia/Neurological Disorders

There are no changes to the diagnosis codes for beta amyloid PET, but effective January 1, 2018, the following HCPCS code will no longer be covered:

A9599

Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (PET) imaging, per study dose, not otherwise specified

Note that there are specific HCPCS codes for florbetapir F-18, flutemetamol F-18, and florbetaben F-18.

 

NCD 210.4.1  Counseling to Prevent Tobacco Use

The following covered codes are added effective October 1, 2015:

F17.213  

Nicotine dependence, cigarettes, with withdrawal

F17.218 

Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.219

Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

F17.223 

Nicotine dependence, chewing tobacco, with withdrawal

F17.228

Nicotine dependence, chewing tobacco, with other nicotine-induced disorders

F17.229     

Nicotine dependence, chewing tobacco, with unspecified nicotine-induced disorders

F17.293     

Nicotine dependence, other tobacco product, with withdrawal

F17.298     

Nicotine dependence, other tobacco product, with other nicotine-induced disorders

F17.299 

Nicotine dependence, other tobacco product, with unspecified nicotine-induced disorders

The following codes are deleted from the covered list effective October 1, 2015:

F17.200

Nicotine dependence, unspecified, uncomplicated

F17.201   

Nicotine dependence, unspecified, in remission

This reflects general CMS policy of not covering codes that are very nonspecific.  Note that F17.210 (Nicotine dependence, cigarettes, uncomplicated) remains a covered code.

In addition to the NCDs for PET scans and tobacco use counseling, Transmittal 1875 also includes changes to the codes for the vagus nerve stimulation and hepatitis C screening NCDs.