10/01/2019
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R5
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Revision Number: 5 Publication: September 2019 Connection LCR A/B 2019-058
Explanation of Revision: Based on CR 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes”, “Revenue Codes”, “CPT/HCPCS Codes”, “ICD-10 Codes that Support Medical Necessity”, “Documentation Requirements” and “Utilization Guidelines” sections of the LCD) and place them into a newly created billing and coding article. In addition, during the process of moving the ICD-10-CM diagnosis codes to the billing and coding article, the ICD-10-CM diagnosis code ranges were broken out and listed individually. Also, the CMS IOM language has been removed from the LCD and instead, the IOM citation related to this language is referenced in the “CMS National Coverage Policy” and “History/Background and/or General Information” sections of the LCD. The effective date of this revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018.
Also, the following unspecified ICD-10-CM diagnosis codes were removed as it is the provider’s responsibility to code to the highest level of specificity: A40.9, A41.9, E03.9, E04.9, E06.9, E07.9, E10.3219, E10.3299, E10.3319, E10.3399, E10.3419, E10.3499, E10.3519, E10.3529, E10.3539, E10.3549, E10.3559, E10.3599, E10.37X9 E10.8, E11.3219, E11.3299, E11.3319, E11.3399, E11.3419, E11.3499, E11.3519, E11.3529, E11.3539, E11.3549, E11.3559, E11.3599, E11.37X9, E11.8, E13.3219, E13.3299, E13.3319, E13.3399, E13.3419, E13.3499, E13.3519, E13.3529, E13.3539, E13.3549, E13.3559, E13.3599, E13.37X9, E13.8, E85.9, E87.70, G90.9, I01.9, I05.9, I06.9, I07.9, I08.9, I09.9, I15.9, I20.9, I21.3, I22.9, I24.9, I25.119, I25.709, I25.719, I25.729, I25.739, I25.759, I25.769, I25.799, I25.9, I27.9, I28.9, I30.9, I31.9, I34.9, I35.9, I36.9, I37.9, I40.9, I42.9, I44.30, I44.60, I45.10, I45.9, I49.40, I49.9, I50.20, I50.30, I50.40, I50.9, I51.9, I70.209, I70.219, I70.229, I70.239, I70.249, I70.269, I70.299, I70.309, I70.319, I70.329, I70.339, I70.349, I70.369, I70.399, I70.409, I70.419, I70.429, I70.439, I70.449, I70.469, I70.499, I70.509, I70.519, I70.529, I70.539, I70.549, I70.569, I70.599, I70.609, I70.619, I70.629, I70.639, I70.649, I70.669, I70.699, I70.709, I70.719, I70.729, I70.739, I70.749, I70.769, I70.799, I72.9, I73.9, I74.10, I74.4, I74.9, I75.019, I75.029, I77.70, I77.9, I78.9, M05.019, M05.029, M05.039, M05.049, M05.059, M05.069, M05.079, M05.119, M05.129, M05.139, M05.149, M05.159, M05.169, M05.179, M05.219, M05.229, M05.239, M05.249, M05.259, M05.269, M05.279, M05.319, M05.329, M05.339, M05.349, M05.359, M05.369, M05.379, M05.419, M05.429, M05.439, M05.449, M05.459, M05.469, M05.479, M05.519, M05.529, M05.539, M05.549, M05.559, M05.569, M05.579, M05.619, M05.629, M05.639, M05.649, M05.659, M05.669, M05.679, M05.719, M05.729, M05.739, M05.749, M05.759, M05.769, M05.779, M05.819, M05.829, M05.839, M05.849, M05.859, M05.869, M05.879, M05.9, M06.019, M06.029, M06.039, M06.049, M06.059, M06.069, M06.079, M06.219, M06.229, M06.239, M06.249, M06.259, M06.269, M06.279, M06.319, M06.329, M06.339, M06.349, M06.359, M06.369, M06.379, M06.819, M06.829, M06.839, M06.849, M06.859, M06.869, M06.879, M06.9, M08.019, M08.029, M08.039, M08.049, M08.059, M08.069, M08.079, M08.219, M08.229, M08.239, M08.249, M08.259, M08.269, M08.279, M08.419, M08.429, M08.439, M08.449, M08.459, M08.469, M08.479, M08.819, M08.829, M08.839, M08.849, M08.859, M08.869, M08.879, M08.90, M08.919, M08.929, M08.939, M08.949, M08.959, M08.969, M08.979, M1A.1190, M1A.1191, M1A.1290, M1A.1291, M1A.1390, M1A.1391, M1A.1490, M1A.1491, M1A.1590, M1A.1591, M1A.1690, M1A.1691, M1A.1790, M1A.1791, M12.019, M12.029, M12.039, M12.049, M12.059, M12.069, M12.079, M31.9, M32.10, M32.9, M33.90, M33.91, M33.92, M33.93, M33.99, M34.9, M35.9, M79.603, M79.606, M79.609, M79.629, M79.639, M79.643, M79.646, M79.669, M79.673, M79.676, Q20.9, Q21.9, Q22.9, Q23.9, Q24.9, Q25.40, Q25.9, Q26.9, Q27.30, Q27.9, Q28.9, R00.9, R06.00, R06.9, R07.9, R20.9, R57.9, S26.00XA, S26.00XD, S26.00XS, S26.10XA, S26.10XD, S26.10XS, S26.90XA, S26.90XD, S26.90XS, S27.309A, S27.309D, S27.309S, S27.319A, S27.319D, S27.319S, S27.329A, S27.329D, S27.329S, S27.339A, S27.339D, S27.339S, S27.399A S27.399D, S27.399S, S29.001A, S29.001D, S29.001S, S29.002A, S29.002D, S29.002S, S29.009A, S29.009D, S29.009S, S29.099A, S29.009D, S29.099S, S29.9XXA, S29.9XXD, S29.9XXS, S39.001A, S39.001D, S39.001S, S39.002A, S39.002D, S39.002S, S39.003A, S39.003D, S39.003S, S39.91XA, S39.91XD, S39.91XS, S39.92XA, S39.92XD, S39.92XS, S39.93XA, S39.93XD, S39.93XS, S39.94XA, S39.94XD, S39.94XS, T36.95XA, T36.95XD, T36.95XS, T37.95XA, T37.95XD, T37.95XS, T38.805A, T38.805D, T38.805S, T38.905A, T38.905D, T38.905S, T39.95XA, T39.95XD, T39.95XS, T40.605A, T40.605D, T05.605S, T40.905A, T40.905D, T40.905S, T41.205A, T41.205D, T41.205S, T42.75XA, T42.75XD, T42.75XS, T43.205A, T43.205D, T43.205S, T43.505A, T43.505D, T43.505S, T43.605A, T43.605D, T43.605S, T43.95XA, T43.95XD, T45.95XS, T44.905A, T44.905D, T44.905S, T45.605A, T45.605D, T45.605S, T45.95XA, T45.95XD, T45.95XS, T46.901A, T46.901D, T46901S, T46.902A, T46.902D, T46.902S, T46.903A, T46.903D, T46.903S, T46.904A, T46.904D, T46.904S, T46.905A, T46.905D, T46.905S, T47.95XA, T47.95XD, T47.95XS, T48.205A, T48.205D, T48.205S, T48.905A, T48.905D, T48.905S, T49.95XA, T49.95XD, T45.95XS, T50.905A, T50.905D, T50.905S, T51.91XA, T51.91XD, T51.91XS, T51.92XA, T51.92XD, T51.92XS, T51.93XA, T51.93XD, T51.93XS, T51.94XA, T51.94XD, T51.94XS, T52.91XA, T52.91XD, T52.91XS, T52.92XA, T52.92XD, T52.92XS, T52.93XA, T52.93XD, T52.93XS, T52.94XA, T52.94XD, T52.94XS, T56.91XA, T56.91XD, T56.91XS, T56.92XA, T56.92XD, T56.92XS, T56.93XA, T56.93XD, T56.93XS, T56.94XA, T56.94XD, T56.94XS, T57.91XA, T57.91XD, T57.91XS, T57.92XA, T57.92XD, T57.92XS, T57.93XA, T57.93XD, T57.93XS, T57.94XA, T57.94XD, T57.94XS, T58.91XA, T58.91XD, T58.91XS, T58.92XA, T58.92XD, T58.92XS, T58.93XA, T58.93XD, T58.93XS, T58.94XA, T58.94XD, T58.94XS, T59.91XA, T59.91XD, T59.91XS, T59.92XA, T59.92XD, T59.92XS, T59.93XA, T59.93XD, T59.93XS, T59.94XA, T59.94XD, T59.94XS, T60.91XA, T60.91XD, T60.91XS, T60.92XA, T60.92XD, T60.92XS, T60.93XA, T60.93XD, T60.93XS, T60.94XA, T60.94XD, T60.94XS, T61.91XA, T61.91XD, T61.91XS, T61.92XA, T61.92XD, T61.92XS, T61.93XA, T61.93XD, T61.93XS, T61.94XA, T61.94XD, T61.94XS, T62.91XA, T62.91XD, T62.91XS, T62.92XA, T62.92XD, T62.92XS, T62.93XA, T62.93XD, T62.93XS, T62.94XA, T62.94XD, T62.94XS, T63.001A, T63.001D, T63.001S, T63.002A, T63.002D, T63.002S, T63.003A, T63.003D, T63.003S, T63.004A, T63.004D, T63.004S, T63.301A, T63.301D, T63.301S, T63.302A, T63.302D, T63.302S, T63.303A, T63.303D, T63.303S, T63.304A, T63.304D, T63.304S, T63.91XA, T63.91XD, T63.91XS, T63.92XA, T63.92XD, T63.92XS, T63.93XA, T63.93XD, T63.93XS, T63.94XA, T63.94XD, T63.94XS, T65.91XA, T65.91XD, T65.91XS, T65.92XA, T65.92XD, T65.92XS, T65.93XA, T65.93XD, T65.93XS, T65.94XA, T65.94XD, T65.94XS, T78.00XA, T78.00XD, T78.00XS, T78.40XA, T78.40XD, T78.40XS, T81.719A, T81.719D, T81.719S, T82.119A, T82.119D, T82.119S, T82.129A, T82.129D, T82.129S, T82.199A, T82.199D, T82.199S, T82.519A, T82.519D, T82.519S, T82.529A, T82.529D, T82.529S, T82.539A, T82.539D, T82.539S, T82.599A, T82.599D, T82.599S, T86.00, T86.10, T86.20, T86.30, T86.40, T86.819, T86.839,T86.859, T86.899, and T86.90. The effective date of this revision is for dates of service on or after 11/12/2019.
In addition, based on CR 11322/CR 11333 (Annual 2020 ICD-10-CM Update) the newly created billing and coding article was revised. Descriptor revised for ICD-10-CM diagnosis codes I70.238 and I70.248. Added ICD-10-CM diagnosis codes I26.93, I26.94, I48.11, I48.19, I48.20, and I48.21. Deleted ICD-10-CM diagnosis codes I48.1 and I48.2. The effective date of this revision is for dates of service on or after 10/01/2019.
10/01/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.
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- Revisions Due To ICD-10-CM Code Changes
- Other (Revisions based on CRs 10901, 11322, 11333)
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