The Centers for Medicare & Medicaid Services (CMS) will implement Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. (See related MLN Matters® article MM9252.) This CR establishes the list of covered conditions and corresponding ICD-10-CM diagnosis codes approved for Bone Mass Measurement studies according to the requirements set forth in National Coverage Determination (NCD) 150.3. CR9252 and accompanying spreadsheet inadvertently omitted the condition of osteopenia and the ICD- 10-CM codes that describe it which are classified to subcategory M85.8- Other specified disorders of bone density and structure. The codes and conditions identified within this subcategory are considered covered indications for bone mass measurement under NCD 150.3 and providers should report these appropriately according to medical documentation. Additional guidance and education as to the updated complete list of covered indications will be forthcoming as CMS continues to review this issue and the systems updates required.
Background
Under ICD-9-CM, the term “Osteopenia” was indexed to ICD-9-CM diagnosis code 733.90 (Disorder of bone and cartilage). This code was listed as a covered condition under the Business requirement 5521.1.1 for CR 5521/NCD 150.3, dated May 11, 2007, when reported with CPT code 77080. (See related MLN Matters article MM5521.) The accompanying Benefit Policy Manual, Publication 100-02, chapter 15, section 80.5.6, Beneficiaries Who May Be Covered, includes: 2. An individual with vertebral abnormalities as demonstrated by an x-ray to be indicative of osteoporosis, osteopenia, or vertebral fracture.
Under ICD-10-CM, the term “Osteopenia” is indexed to ICD-10-CM subcategory M85.8- Other specified disorders of bone density and structure, within the ICD-10-CM Alphabetic Index. The codes within this subcategory were inadvertently omitted from the CMS spreadsheet that accompanied CR 9252 containing the list of covered conditions and corresponding diagnosis codes. These are considered covered for NCD 150.3 indications.
Below is the list of ICD-10-CM diagnosis codes within subcategory M85.8- that providers may report as covered indications in addition to the current list provided in CR 9252 and its accompanying CMS spreadsheet.
** M85.811 Other specified disorders of bone density and structure, right shoulder
** M85.812 Other specified disorders of bone density and structure, left shoulder
** M85.821 Other specified disorders of bone density and structure, right upper arm
** M85.822 Other specified disorders of bone density and structure, left upper arm
** M85.831 Other specified disorders of bone density and structure, right forearm
** M85.832 Other specified disorders of bone density and structure, left forearm
** M85.841 Other specified disorders of bone density and structure, right hand
** M85.842 Other specified disorders of bone density and structure, left hand
** M85.851 Other specified disorders of bone density and structure, right thigh
** M85.852 Other specified disorders of bone density and structure, left thigh
** M85.861 Other specified disorders of bone density and structure, right lower leg
** M85.862 Other specified disorders of bone density and structure, left lower leg
** M85.871 Other specified disorders of bone density and structure, right ankle and
foot
** M85.872 Other specified disorders of bone density and structure, left ankle and foot
** M85.88 Other specified disorders of bone density and structure, other site
** M85.89 Other specified disorders of bone density and structure, multiple sites
