Coding Analysis for Labs (CAL) Tracking Sheet

Urine Culture (Bacterial) and Serum Iron Studies (Revision of ICD-9-CM Codes for Pre-operative Examinations)

CAG-00236N

Issue

[Coding determinations made as part of the Coding Analysis for Laboratory (CAL) process do not constitute National Coverage Determinations (NCDs), but only serve to provide clarification on codes that are covered under a particular laboratory negotiated NCD.]

The list of “ICD-9-CM Code Covered by Medicare” associated with the current national coverage determinations (NCD) for urine culture (bacterial) and serum iron studies include ICD-9-CM code V72.84, pre-operative examination, unspecified.  We have previously reviewed the issue of inclusion of this code in the list of covered services for prothrombin time (PT) and partial thromboplastin time (PTT) tests.  (See www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=93.) We concluded that it is not appropriate under the Medicare statute to include codes for routine screening services in the list of covered codes for PT and PTT tests. In the decision memorandum for this issue, we noted that we would also reconsider the inclusion of V72.84 in the list of covered codes for urine culture (bacterial) and serum iron studies.   This lab coding analysis will address that issue.

Benefit Category

Diagnostic Laboratory Tests

Requestor Information

Requestor Name Requestor Letter
Internally generated N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
06/15/2004
Expected CAL Completion Date
09/13/2004
Public Comment Period
06/15/2004 - 07/15/2004
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
07/26/2004

Contacts

Lead Analysts
Jackie Sheridan-Moore
Lead Medical Officers

Medicare Benefit Category Determination Date

Actions Taken

June 15, 2004

Formal request initiated by CMS. The 30-day public comment period begins with this acceptance date, and ends after 30 calendar days. CMS considers all public comments, and is particularly interested in clinical studies and other scientific information relevant to the technology under consideration as well as comments on the appropriate benefit categories to which the technology should be assigned. (This information should be submitted to Jackie Sheridan-Moore at CMS, 7500 Security Blvd., Mailstop C1-09-06, Baltimore, MD 21244-1850.)

July 26, 2004

Posted coding analysis decision memo

August 3, 2004

Posted public comments [PDF, 98KB].

November 26, 2004

Published implementing instructions in transmittal 380 or pub 100-4 (CR3429)