Medical Billing and Coding Healthcare Blog

The Centers for Medicare & Medicaid Services has announced four changes that will be included in the January 2016 quarterly release of the edit module for clinical diagnostic laboratory services.

The changes being made to the National Coverage Determinations (NCD) code lists as follows: 

  1. Addition of ICD-10-CM codes N131 and N132 to the list of ICD-10-CM codes that are covered by Medicare for the Urine Culture, Bacterial (190.12) NCD.
  2. Addition of ICD-10-CM code I481 to the list of ICD-10-CM codes that are covered by Medicare for the Partial Thromboplastin Time (PTT) (190.16) NCD.
  3. Addition of ICD-10-CM code S069X0A to the list of ICD-10-CM codes that are covered by Medicare for the Prothrombin Time (PT) (190.17) NCD.
  4. Addition of ICD-10-CM code I481 to the list of ICD-10-CM codes that are covered by Medicare for the Thyroid Testing (190.22) NCD.

These changes are effective for services furnished on or after October 1, 2015.

Those providing laboratory billing services need to be aware of these changes.

The Centers for Medicare & Medicaid Services (CMS) has issued a new change request (CR) that should be of interest to clinical diagnostic laboratories that submit claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

CR 9465 provides instructions for the calendar year (CY) 2016 clinical laboratory fee schedule, mapping for new codes for clinical laboratory tests and updates for laboratory costs subject to the reasonable charge payment.

Key points of CR 9465 address:

  • national minimum payment amounts;
  • national limitation amounts (maximum);
  • pricing information;
  • organ or disease oriented panel codes;
  • mapping information;
  • blood product codes;
  • transfusion medicine codes; and
  • reproductive medicine procedure codes.

CR 9465 was released less than a month after CMS released its final 2016 clinical lab fee schedule (access the 2016 fee schedule files here).

The rules governing laboratory billing are complex and ever-changing, which is why more and more clinical and reference laboratories are taking advantage of PGM's laboratory billing services. Over the past 30 years, PGM has developed one of the most effective laboratory financial management services in the country. PGM handles all aspects of billing, including both the technical and professional components.With PGM, labs effectively manage high-volume, small-dollar claims, improve collection rates and gain revenue cycle management insight.

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