Revision to LCD for Outpatient Physical and Occupational Therapy (L26884)

In 2010, National Government Services received a request for reconsideration of the Outpatient Physical and Occupational Therapy local coverage determination (LCD) (L26884) to include International Classification of Diseases, Clinical Modification, 9th Revision (ICD-9-CM) codes V57.1-V57.89 as correct coding. Review of the ICD-9-CM manual indicated that the request was technically correct, and therefore the requirement was included in the May 2010 draft revision to the LCD. Numerous comments were received from all National Government Services jurisdictions that such coding was redundant and created additional burden for providers.

The National Government Services medical directors and policy staff agreed with these comments, and sought further guidance from the Centers for Medicare & Medicaid Services (CMS) about whether these diagnosis codes needed to be included in the LCD. CMS has indicated that although the ICD-9-CM manual does include this recommendation, contractors did not have to include these diagnoses in the LCD.

Consequently, the LCD and supplemental instruction article (SIA) are revised, effective November 1, 2010, to delete coding instructions that required ICD-9-CM codes V57.1-V57.89 be included as the primary diagnosis on all therapy claims. Furthermore, National Government Services will not require these diagnosis codes as primary or subsequent codes. National Government Services does, however, note that such a recommendation does exist in the ICD-9-CM manual. If providers use these codes, they must also include the diagnosis code of the specific medical condition for which each therapy service was provided.

To see the document on the NGS website, click on www.NGSMedicare.com, select your Business Type and your Region and click “Go.” On the Provider Specific Portal Home Page, under News and Publications, click on What’s New from the drop down menu.

Source: Gawenda Seminars & Consulting