NCDs & LCDs Released With Covered ICD-10 Codes: Will Your Documentation Support Medical Necessity?

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Despite the delay, the conversion to ICD-10-CM will actually happen this year. To that end, the Centers for Medicare & Medicaid Services (CMS) has posted its future effective national coverage determinations (NCDs) with covered ICD-10 codes that will take effect Oct. 1. An alphabetized list of NCDs can be found here.

Likewise, many Medicare Administrative Contractors (MACs) have posted their future effective local coverage determinations (LCDs) with covered ICD-10 codes that will also take effect Oct. 1. The LCDs for individual states can be found online as well. Wound care providers and program directors can also find these future effective LCDs on each MAC’s website. (See Table 1 and Table 2 for a list of MACs, the states and territories covered, and their websites.) Throughout 2014, this author provided wound care-specific documentation relating to ICD-10 codes. These educational materials will continue through most of 2015 in Today’s Wound Clinic.

After reading these ICD-10 educational tools, wound care professionals should better understand how their documentation should lead to appropriate specific ICD-10 codes that describe their patients’ primary diagnosis, comorbidities, and other contributing diagnoses.

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See Table 3* in the PDF version to gain a better appreciation of the coverage and medical necessity documentation that will be required by MACs when ICD-10 codes take effect and for extracts of several of the MACs’ LCDs. This table also provides a partial review of some MACs’ future effective LCDs. The table has been designed to provide the following information:

• contractor name;• future effective LCD number;
• LCD title;• ICD-10 codes relative to demonstrating medical necessity, according to the LCD; and
• conditions that demonstrate medical necessity and documentation needed to have codes that are as specific as possible.NOTE: Not all codes and conditions are provided in Table 3. The information is not exhaustive, but is meant to show a sampling of what is included in the body of these LCDs. Also, note that the LCDs are accurate as of Feb. 24. Be sure to visit your MAC’s website or the CMS coverage 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, Table 3 contains only a partial list of ICD-10 codes specified among the sample LCDs. All wound care professionals should read, download, and implement those NCDs and LCDs that pertain to one’s particular work. There are many wound care-related LCDs that strictly focus on documentation of procedures, not on the documentation of patients’ particu

lar diagnosis(es). These LCDs are not included in Table 3 because they involve primarily Current Procedural Terminology coding, which is not the subject of this article. Be sure to review all previous ICD-10-related articles, as they will also assist in understanding some of the LCDs in Table 3 as well as all future effective NCDs and LCDs published by CMS and MACs. Here’s to a productive year of improving clinical documentation to successfully transition to ICD-10! n

*In order to locate the new ICD-10 LCDs, refer to the indexes section of the CMS coverage site. Select the LCDs by your MAC and select the future effective policies link. All policies listed in the future effective section contain the information on the new ICD-10 policies effective Oct. 1. Donna Cartwright is senior director of strategic reimbursement at Integra LifeSciences Corp., Plainsboro, NJ, and an American Health Information Management Association-approved ICD-10 trainer. She may be reached for questions at 609-936-2265 or donna.cartwright@integralife.com.