2021 ICD-10 Local Coverage Determination (LCD) and Local Coverage Article (LCA) Updates

The following LCA's have been revised under contractor numbers: 0112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, NMI), 01312 (NV).

Effective: October 1, 2021

Summary of Changes: The following LCAs have been updated to add, change description and/or remove ICD-10 codes.

LCD Title LCD/LCA Number ICD-10 Added ICD-10 Deleted ICD-10 Description Change
Respiratory Care (Respiratory Therapy) / Billing and Coding: Respiratory Care (Respiratory Therapy) L34149/A57224 R05.1 - Acute cough
R05.2 - Subacute cough
R05.3 - Chronic cough
R05.4 - Cough syncope
R05.8 - Other specified cough
R05 - Cough M35.02 - Sjogren syndrome with lung involvement
Peripheral Nerve Stimulation / Billing and Coding: Peripheral Nerve Stimulation L34328/A55530 G44.86 - Cervicogenic headache N/A N/A
Nerve Conduction Studies and Electromyography / Billing and Coding: Nerve Conduction Studies and Electromyography L36524/A54969 M35.06 - Sjogren syndrome with peripheral nervous system involvement N/A M35.03 - Sjogren syndrome with myopathy
Nerve Blockade for Treatment of Chronic Pain and Neuropathy L35456/A56034 M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M54.5 - low back pain N/A
MRI & CT Scans of the Head and Neck / Billing and Coding: MRI & CT Scans of the Head and Neck L37373/A57204 C84.7A
E75.244
F78.A1
F78.A9
G04.82
G44.86
G92.00
G92.01
G92.02
G92.03
G92.04
G92.05
G92.8
M31.11
M31.19
S06.A0XA
S06.A0XD
S06.A0XS
S06.1ASA
S06.A1XD
S06.A1XS
F78 - Other intellectual disabilities
G92 - Toxic encephalopathy
M31.1 - Thrombotic microangiopathy
N/A
Lumbar Epidural Injections / Billing and Coding: Lumbar Epidural Injections L34982/A57202 M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M54.5 - Low back pain N/A
Immune Globulin Intravenous (IVIg) / Billing and Coding: Immune Globulin Intravenous (IVIg) L34314/A57187 M31.10 - Thrombotic microangiopathy, unspecified
M31.19 = Other thrombotic microangiopathy
M31.1 - Thrombotic microangiopathy N/A
Billing and Coding: Positron Emission Tomography Scans Coverage A56666 Group 4:
C56.3 - Malignant neoplasm of bilateral ovaries
C84.7A - Anaplastic large cell lymphoma, ALK-negative breast
Group 5:
C79.63 - Secondary malignant neoplasm of bilateral ovaries
Group 17 - added coverage for infection and inflammation
N/A N/A
Billing and Coding: Posterior Tibial Nerve Stimulation Coverage A55104 R35.81 - Nocturnal polyuria
R35.89 - Other polyuria
N/A N/A
Billing and Coding: Routine Foot Care A57954 Group 2:
E75.244 - Niemann-Pick disease type A/B
M35.06 - Sjogren syndrome with peripheral nervous system involvement
Group 3:
M35.0B 0 Sjogren syndrome with Vasculitis
N/A N/A
Controlled Substance Monitoring and Drugs of Abuse Testing / Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing L36668/A55001 R45.88
T70.711A
T70.711D
T70.711S
T40.712A
T40.712D
T40.712S
T40.713A
T40.713D
T40.713S
T40.714A
T40.714D
T40.714S
T40.721A
T40.721D
T40.721S
T40.722A
T40.722D
T40.722S
T40.723A
T40.723D
T40.723S
T40.724A
T40.724D
T40.724S
M54.5 - Low back pain
T40.7X1A - Poisoning by cannabis (derivatives), accidental (unintentional) initial encounter
T40.7X2A - Poisoning by cannabis (derivatives), intentional self-harm, initial encounter
T40.7X3A - Poisoning by cannabis (derivatives), assault, initial encounter
T40.7X4A - Poisoning by cannabis (derivatives), undetermined initial encounter
N/A
Lumbar MRI / Billing and Coding: Lumbar MRI L34220/A57206 C56.3 - Malignant neoplasm of bilateral ovaries
M54.50 - Low back pain, unspecified
M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M54.5 - Low back pain N/A
MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease / Billing and Coding: MolDX: Genetic Testing for BCR-ABL Negative Myeloproliferative Disease L36180/A57421 D75.838 - Other thrombocytosis N/A N/A
MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels / Billing and Coding: MolDX: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels L37301/A57338 R05.1
R05.2
R05.3
R05.8
T80.82XS
Z92.850
Z92.858
Z92.86
R05 - Cough N/A
MolDX: NRAS Genetic Testing / Billing and Coding: MolDX: NRAS Genetic Testing L36335/A57486 C79.63 - Secondary malignant neoplasm of bilateral ovaries C79.9 - Secondary malignant neoplasm of unspecified site N/A
MolDX: Next-Generation Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies / Billing and Coding: MolDX: Next-Generation Lab-Developed Tests for Myeloid Malignancies and Suspected Myeloid Malignancies L38123/A57891 D75.838 - Other thrombocytosis N/A N/A
Trigger Point Injections / Billing and Coding: Trigger Point Injections L34211/A57701 M54.59 - Other low back pain
M54.50 - Low back pain, unspecified
M54.5 - Low back pain N/A
Billing and Coding: Bariatric Surgery Coverage A53026 M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M54.5 - Low back pain Z68.41 - Body mass index [BMI] 40.0-44.9, adult
Billing and Coding: MolDX: Avise PG Assay A54376 N/A N/A Z92.25 - Personal history of immunosuppression therapy
Billing and Coding: MolDX: FDA-Approved KRAS Tests A54498 C79.63 - Secondary malignant neoplasm of bilateral ovaries N/A N/A
Billing and Coding: MolDX: bioTheranostics Cancer TYPE ID® A54386 C56.3 - Malignant neoplasm of bilateral ovaries
M79.63 - Secondary malignant neoplasm of bilateral ovaries
N/A N/A
Billing and Coding: B-Type Natriuretic Peptide (BNP) Testing A57083 I5A - Non-ischemic myocardial injury (non-traumatic) N/A N/A
Billing and Coding: Chest X-Ray A57497 M54.50 - Low back pain, unspecified
M54.51 - Vertebrogenic low back pain
M54.59 - Other low back pain
M54.5 - Low back pain N/A
Billing and Coding: Intensity Modulated Radiation Therapy (IMRT) A58236 C56.3 - Malignant neoplasm of bilateral ovaries
C79.63 - Secondary malignant neoplasm of bilateral ovaries
C84.7A - Anaplastic large cell lymphoma, ALK-negative, breast
N/A N/A
Billing and Coding: Vitamin D Assay Testing A57718 N/A N/A Z68.30 - Body mass index [BMI] 30.0-30.9, adult
Z68.41 - Body mass index [BMI] 40.1-44.9, adult
Serum Magnesium / Billing and Coding: Serum Magnesium L36702/A57189 M35.05
M35.06
M35.07
M35.08
M35.0A
M35.0B
M35.0C
P00.82
R79.83
R63.3 - Feeding difficulties
T40.7X5A - Adverse effect of cannabis (derivatives), initial encounter
T40.7X5D - Adverse effect of cannabis (derivatives), subsequent encounter
T40.7X5S - Adverse effect of cannabis (derivatives), sequela
M35.04 - Sjogren syndrome with tubulo-interstitial nephropathy
Electrocardiograms / Billing and Coding: Electrocardiograms L34315/A57326 N/A N/A T63.661A
T63.611D
T63.611S
T63.612A
T63.612D
T63.612S
T63.613A
T63.613D
T63.613S
T63.614A
T63.614D
T63.614S
Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea / Billing and Coding: Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea L38310/A57948 N/A N/A Z68.30 - Body mass index [BMI] 30.0-30.9, adult
Lab: Flow Cytometry / Billing and Coding: Lab: Flow Cytometry L36094/A57690 C79.63 - Secondary malignant neoplasm of bilateral ovaries
C84.7A - Anaplastic large cell lymphoma ALK-negative breast
D75.838 - Other thrombocytosis
N/A N/A

 

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            Last Updated Tue, 05 Oct 2021 17:13:38 +0000