At the time Medicare developed the national coverage determinations (NCDs) for clinical diagnostic laboratory services under the negotiated rulemaking authority, Medicare did not have a colorectal cancer screening benefit. Consequently, we included ICD-9-CM code V76.51, Special screening for malignant neoplasms of colon, on the list of codes that are not covered by Medicare. Subsequently, the Medicare statute was amended to add colorectal cancer screening as a covered Medicare benefit. In implementing this new statutory benefit, we neglected to remove the code for Special screening for malignant neoplasms of colon, V76.51, from this list.
The development of the NCDs for clinical diagnostic laboratory services incorporated the development of a list, "Non-covered ICD-9-CM Codes List for All NCD Edits". In addition, each clinical laboratory NCD includes a list, "ICD-9-CM codes Covered by Medicare Program". For all of these clinical laboratory NCDs with the exception of the Blood Counts NCD, each covered code is enumerated in the list.
Differing from other clinical diagnostic laboratory NCD covered code lists, the Blood Counts NCD covered code list is constructed as an exclusionary rather than inclusionary list, and individual covered codes are not enumerated. Instead, the Blood Count NCD covered codes list includes all ICD-9-CM codes excluding those listed on either the "Non-covered ICD-9-CM Code List for All NCDs" or on the "ICD-9-CM Codes That Do Not Support Medical Necessity List" for blood counts.
Because of this exclusionary aspect of code coverage for blood counts, removal of V76.51 from the non-covered code list would automatically result in inappropriate inclusion of V76.51 on the list of codes covered by Medicare list for the Blood Count NCD. Therefore, we are proposing to remove V76.51 from the list "Non-covered ICD-9-CM Codes List for All NCD Edits" and add it to the "ICD-9-CM Codes That Do Not Support Medical Necessity List" for blood counts. We are seeking public input on this matter.
