Review of LCDs Released After ICD-10-CM Conversion

Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure the accuracy of the information. However, HMP Communications and the authors do not represent, guarantee, or warranty that the coding, coverage, and payment information is error-free and/or that payment will be received. The ultimate responsibility for verifying coding, coverage, and payment information accuracy lies with the reader.

Medicare Administrative Contractors (MACs) have posted their effective local coverage determinations (LCDs) with covered ICD-10-CM codes that took effect on or after Oct. 1, 2015. Wound care professionals should review their respective MAC’s active, future-effective, and draft LCDs that pertain to the services/procedures performed and/or the products they use.  The best way to locate one’s MAC LCDs is to use the Medicare Coverage Database: www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx. (The “indexes” tab above the search engine is useful when searching for LCDs by contractor or by state.) Throughout 2014-15, this journal provided wound care-specific documentation articles relating to ICD-10 codes^1,2 that have assisted wound care professionals in better understanding how their documentation should lead to appropriate and specific ICD-10 coding that describes their patients’ primary diagnosis, comorbidities, and other contributing diagnoses.

In preparation for ICD-10 implementation, most wound care professionals reviewed their MAC LCDs to identify the covered ICD-10 codes. Unfortunately, many wound care professionals have reported that they have not looked at the Medicare Coverage Database since ICD-10 was implemented. Because MACs can update their LCDs at any time, wound care professionals should establish a process to review their MAC LCDs on a monthly basis.  Regarding those LCDs pertinent to wound care following ICD-10 implementation, some MACs haven’t revised their LCDs since Oct. 1, 2015, while others have revised their LCDs multiple times. The Table beginning on page 7 will help readers gain a better appreciation of the coverage and medical necessity documentation that is required by MACs now that ICD-10 codes are a reality. The Table includes a sampling of post-ICD-10 implementation LCDs and provides the following information for each:

• contractor name;

• LCD number and effective date;

• LCD title;

• ICD-10 codes (partial listing) that demonstrate medical necessity, according to the LCD;

• documentation elements required for specificity and medical necessity; and

• links to LCDs.

NOTE: The Table does not include all covered ICD-10 codes and conditions. The information is not exhaustive and is meant to provide a sampling of what is included in the body of these LCDs. Also note the LCD information is accurate as of Jan. 25, 2016. Wound care professionals should visit the Medicare Coverage Database or the MAC’s website to obtain the most current and complete LCDs and attached articles.

Some LCDs are 75 pages long due to specific ICD-10 codes listed for covered indications. For this reason, the Table contains only a partial list of ICD-10 codes specified in the sample LCDs. All wound care professionals should download, read, and implement the LCDs that pertain to their particular work. Some wound care-related LCDs strictly focus on documentation of procedures, not on the documentation of patients’ particular diagnosis(es). These LCDs are not included in the Table because they involve primarily Current Procedural Terminology coding, which is not the subject of this article. 

Donna J. Cartwright, MPA, RHIA, CCS, RAC, FAHIMA, is senior director, reimbursement services, national policy and payer access at Integra LifeSciences Corp., Plainsboro, NJ, and an approved ICD-10 trainer by the American Health Information Management Association. She may be reached for questions at 609-936-2265 or at donna.cartwright@integralife.com. Kathleen D. Schaum & Associates Inc., Lake Worth, FL; and director, medical products, reimbursement, biotherapeutics at Smith & Nephew.