Osteogenesis Stimulator Policy Revision FAQs - JA DME

Question 1: Why have the diagnosis codes been removed from the revised policy?
Answer: The ICD-9 to ICD-10 cross-walk resulted in a policy that was very long and unwieldy.

The cross-walked policy was also lacking diagnosis codes for "subsequent encounters". The National Coverage Determination (NCD) for osteogenesis stimulators does not contain any diagnosis codes, and the medical directors have adopted the NCD's narrative format in this revision.

Question 2: Do we still have to submit the applicable diagnosis codes on the claims?
Answer: Yes, it is a claim processing system requirement that a diagnosis code(s) must be included on all claims.

Question 3: Do we still need to submit a Certificate of Medical Necessity (CMN) with the initial claim?
Answer: Yes. The removal of diagnosis codes from the Local Coverage Determination (LCD) does not change the requirement to submit a properly completed CMN for these items.

Question 4: What diagnosis code(s) should the physician/qualified provider use on the CMN?
Answer: The physician/provider should use an ICD-10 code that is applicable to the particular beneficiary's medical condition. An ICD-10 diagnosis code is not used to determine reimbursement. During a claim review, information contained in the contemporaneous medical record is what is used to justify that the required payment rules are met.

Question 5: With the removal of the ICD-10 diagnosis codes, has any of the coverage criteria for osteogenesis stimulators changed?
Answer: No. Coverage criteria for osteogenesis stimulators remains unchanged.