Changes to local coverage determinations coming with ICD-10

As part of ICD-10, all local coverage determinations (LCDs) will be updated to reflect the appropriate ICD-10 codes. The LCDs and their associated ICD-10 articles will receive new LCD/article reference numbers. CMS has said that the new numbers will be published on the Medicare Coverage Database (MCD) no later than April 10, 2014.

The new reference number could have an impact on Medicare Audit Contractors' (MAC) local systems, such as by changing their Medicare Summary Notice to capture the new number. However, CMS has determined that this number change will not mean that the policies are considered new policies. Instead, CMS considers this a coding revision that does not change the intent of coverage/noncoverage by an LCD. Therefore, if a MAC chooses to only translate ICD-9 codes to the appropriate ICD-10 code, the policy does not need to be vetted through their Carrier Advisory Committee or be sent through the public comment and notice process.

A MAC may choose to revise more than just the diagnosis codes. If so, it will need to follow the normal LCD development process outlined in the Medicare Program Integrity Manual, Publication 100-08, Chapter 13 (Local Coverage Determinations), available on the CMS website.