Lab NCDs - ICD-10
Guidance for the ICD-10-CM code set as used (instead of ICD-9-CM) by all covered entities to encode diagnoses in HIPAA-regulated transactions, such as Medicare billing claims for diagnostic clinical laboratory services.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: June 24, 2020
Transition from ICD-9-CM to ICD-10-CM for the Lab NCDs
Based on the 2010 Affordable Care Act (2010), the ICD-10-CM codeset is used (instead of ICD-9-CM) by all covered entities to encode diagnoses in HIPAA-regulated transactions, such as Medicare billing claims for diagnostic clinical laboratory services. Following the provisions of the Preserving Access to Medicare Act (2014), the effective date of this transition from ICD-9-CM to ICD-10-CM was October 1, 2016. For more details about the implementation of ICD-10-CM coding, please see the website /ICD10 .
Please note that CMS followed the Partial Code Freeze for ICD-9-CM and ICD-10 updates from October 1, 2011 through September 30, 2016. Information about the Partial Code Freeze is available at /Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf (PDF). **
To achieve maximal clinical equivalence of ICD-9-CM and ICD-10-CM codes, CMS has used the General Equivalence Mappings (GEMs) to convert ICD-9-CM codes to ICD-10-CM codes. The GEMs have been posted by CMS for 2018. Now that ICD-10-CM codes have been effective for a few years, 2018 is the last year that CMS will use the GEMs. The last GEMs (2018) can be accessed at /ICD10.
Please note that due to the voluminous number of codes involved in the October 2018 update of ICD-10 codes, the Medicare shared systems will implement the new codes in the January 2019 quarterly update. The October 2018 update will include all deleted and replacement ICD-10-CM codes. As noted, the January 2019 CR will include new ICD-10-CM codes. While the implementation date will be in January, the effective date of the new codes will still be October 1, 2018. All deleted codes will not be valid for payment after September 30, 2018. Contractors will be instructed to adjust claims brought to their attention.
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