CMS and Medicare Administrative Contractors (MAC) are aware of certain issues regarding National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) related to ICD-10 and working to resolve them as soon as possible, according to CMS.

 

In response to feedback from industry stakeholders regarding specific NCDs, CMS has offered additional clarifications and coding refinements. CMS updated its claims processing instructions and published new translation spreadsheets as noted in MLN Matters article 9252.

 

Most claims inappropriately rejected or denied due to isolated NCD issues have been reprocessed and required no additional action by providers, according to CMS. For more information for NCDs regarding specific claims types and reprocessing, providers should check their MACs’ website. A permanent systems update will be in place by January 4, 2016.

 

MACs are continuing to work on fixing issues with LCDs as well. All MACs updated LCDs prior to ICD-10 implementation and have identified some LCDs that required further refinement to edits to add allowable ICD-10-CM codes. Claims affected by these edits with dates of service on or after October 1, 2015, have been suspended until fixes are implemented, according to CMS. Once the LCDs are implemented, MACs are expected to reprocess the claims, with any inappropriately denied before the updates to be automatically reprocessed.

Additional LCDs found to have similar issues will follow the same process, according to CMS, and providers should direct specific questions about LCDs to their MAC.