03/21/2021
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R14
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This revised LCD published 02/04/2021 will become effective 03/21/2021. The proposed LCD and related Billing and Coding Article was developed jointly by Novitas and First Coast to delineate appropriate indications for performance of diagnostic colonoscopy and will provide limited coverage for diagnostic colonoscopy to confirm or rule out suspected conditions in symptomatic patients. Coverage indications and limitations were revised to match the evidence presented in the bibliography. Summary of evidence and analysis of evidence sections were added to comply with the 21st Century Cures Act.
Proposed LCD posted for comment on 09/24/2020.
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- Creation of Uniform LCDs With Other MAC Jurisdiction
- Automated Edits to Enforce Reasonable & Necessary Requirements
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10/29/2020
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R13
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LCD revised and published on 11/05/2020 effective for dates of service on and after 10/29/2020. Correction made to Revision effective date.
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10/29/2019
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R12
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LCD revised and published on 10/29/2020 effective for dates of service on and after 10/29/2020. The statement, “For screening colonoscopies, refer to the Local Coverage Determination Colorectal Cancer Screening” was removed based on the retirement of the LCD. In addition, formatting changes were made throughout the article. (PITL # 2020PITLAB005)
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07/30/2019
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R11
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12/06/2019: The content in the LCD was revised to be consistent with the new format supported by CMS IOM Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.5.1.
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07/30/2019
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R10
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Revision Number: 8 Publication: August 2019 Connection LCR A/B2019-046
Explanation of Revision: Based on review of the LCD, typographical and formatting errors were identified and corrected. Also, the Bibliography section of the LCD was updated to be consistent with AMA formatting. The effective date of this revision is based on date of service.
07/30/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.
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04/01/2019
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R9
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Revision Number: 7 Publication: April 2019 Connection LCR A/B2019-029
Explanation of Revision: Based on Change Request (CR) 10937, the LCD was revised to add Internet-Only Manual (IOM) references in the “CMS National Coverage Policy” section of the LCD related to incomplete colonoscopies billed with Modifier 53 for Critical Access Hospital (CAH) Method II Providers. In addition, the LCD was revised to remove outdated language on payment methodology from the “Coverage Indications, Limitations, and/or Medical Necessity” section of the LCD related to when a covered colonoscopy is attempted but cannot be completed, and instead the IOM citation related to this language is referenced in the “CMS National Coverage Policy” section of the LCD. The effective date of this LCD revision is for dates of service on or after April 1, 2019. Additionally, based on CR 10901, the LCD was revised to remove all billing and coding and all language not related to reasonable and necessary provisions (“Bill Type Codes,” “Revenue Codes,” “CPT/HCPCS Codes,” “ICD-10 Codes that Support Medical Necessity,” “Documentation Requirements,” and “Utilization Guidelines” sections of the LCD) and place them into the billing and coding article. The effective date of this LCD revision is for claims processed on or after January 8, 2019, for dates of service on or after October 3, 2018.
04/01/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.
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- Other (Revisions due to Change Requests (CR) 10937 and 10901)
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01/29/2019
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R8
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Revision Number: 6 Publication: February 2019 Connection LCR A/B2019-018
Explanation of Revision: Based on review of the LCD, grammatical errors were corrected. The effective date of this revision is based on process date. In addition, the “Sources of Information” section of the LCD was revised to update the sources. The effective date of this revision is based on date of service.
01/29/2019: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this LCD.
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- Other (Revision based on external inquiry.)
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05/17/2018
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R7
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Revision Number: 5
Publication: March 2018 Connection
LCR A/B2018-020
Explanation of Revision: Based on an external inquiry this LCD was revised to remove ICD-10-CM diagnosis codes Z12.10, Z12.11, Z12.13, Z80.0, Z83.71 - Z83.79, Z85.038, Z85.048 and Z86.010 from the ICD-10 Codes that Support Medical Necessity” section of the LCD.The effective date of this revision is based on date of service
05/17/2018: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Other (Revisions made based on an external inquiry.)
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10/01/2017
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R6
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Revision Number: 4
Publication: September 2017 Connection
LCR A/B2017-038
Explanation of Revision: Based on CR 10153 (Annual 2018 ICD-10-CM Update) the LCD was revised. Added ICD-10-CM diagnosis codes K56.50 – K56.52, K56.600 – K56.699. Deleted ICD-10-CM diagnosis codes K56.5, K56.60, K56.69. The effective date of this revision is based on date of service.
10/01/2017: At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination and therefore not all the fields included on the LCD are applicable as noted in this policy.
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- Revisions Due To ICD-10-CM Code Changes
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10/01/2016
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R5
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Revision Number: 3 Publication: October 2016 Connection LCR A/B2016-097
Explanation of Revision: Based on CR 9677 (Annual 2017 ICD-10-CM Update) the LCD was revised to add ICD-10-CM diagnosis codes C49.A0, C49.A3, C49.A4, C49.A5, C49.A9, K55.011, K55.012, K55.019, K55.021, K55.022, K55.029, K55.031, K55.032, K55.039, K55.041, K55.042, K55.049, K55.051, L55.052, K55.059, K55.061, K55.062, K55.069, K55.30, K55.31, K55.32, and K55.33. In addition, ICD-10-CM diagnosis code K55.0 was deleted. The effective date of this revision is based on date of service.
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- Revisions Due To ICD-10-CM Code Changes
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01/01/2016
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R4
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Revision Number: 2 Publication: December 2015 Connection LCR A/B2016-005
Explanation of revision: Annual 2016 HCPCS Update. CPT codes G6019, G6020, G6021, G6024, and G6025 were deleted. The effective date of this revision is based on date of service.
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- Revisions Due To CPT/HCPCS Code Changes
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10/01/2015
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R3
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Revision Number: 1 Publication: November 2015 Connection LCR A/B2015-019
Explanation of revision: This LCD was revised to add ICD-10-CM diagnosis codes C45.9, C79.9, D13.2, D13.30, D13.39, D19.1, K57.00 – K57.01, K59.00 – K59.09, and K63.5 to the “ICD-10 Codes that Support Medical Necessity” section of the LCD. In addition, the LCD was revised to expand the ulcerative colitis ICD-10-CM diagnosis range to K51.00 – K51.919. The effective date of this revision is for claims processed on or after 11/06/15, for dates of service on or after 10/01/15.
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- Revisions Due To ICD-10-CM Code Changes
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10/01/2015
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R2
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5/29/2015-The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
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- Provider Education/Guidance
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10/01/2015
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R1
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3/13/2015: The language and/or ICD-10-CM diagnoses were updated to be consistent with the current ICD-9-CM LCD’s language and coding.
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- Revisions Due To ICD-10-CM Code Changes
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