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Lab NCDs - ICD-10

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 will be no earlier than October 1, 2015.  For more details about the implementation of ICD-10-CM coding, please see the website www.cms.gov/ICD10 .

In consultation with its contractors and after review 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 2015 at www.cms.gov/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 http://www.cms.gov/Medicare/Coding/ICD10/Downloads/Partial_Code_Freeze.pdf. **

Please note that due to this being the first regular ICD-10 code update since the partial code freeze October 1, 2011, (there were limited new codes introduced in fiscal years 2012, 2013, 2014, and 2015), and the voluminous number of new codes involved, the Medicare shared systems will split implementation of the new codes over the January 2017 and April 2017 quarterly updates. While the implementation dates will be in January and April, the effective dates of the new codes will still be October 1, 2016. All deleted codes will not be valid for payment after September 30, 2016. Contractors will be instructed to adjust claims brought to their attention.

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