MAC LCD Update

I do want to update everyone on the Novitas MAC LCD (local coverage determinant).  The draft will become policy on April 9, 2015.  To view the policy as well as the various comments and Novitas responses you can go here:!

Here is a quick summary of some of the changes from the original draft:

  1. Code 00810 (lower endoscopy) has been removed from the policy
  2. For any condition in a pediatric patient, Medicare eligible and younger than 18 years of age, use ICD-9-CM code 999.9
  3. This ICD 9 code was added in the final version: V15.80 PERSONAL HISTORY OF FAILED MODERATE SEDATION
  4. Pediatric age was changed from 12 to 18
  5. For patients with mental retardation (patients who are uncooperative due to a lack of understanding caused by their mental disability), use ICD-9-CM code 319
  6. “Procedures listed below usually do not require general, regional, or MAC anesthesia.” In the final version, it now states: “Procedures listed below represent commonly used anesthesia codes that may involve MAC. When these codes are used and MAC has been provided, the QS modifier must be used.”

Peter Goldzweig, DO

NJSSA President

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Written by Stephanie Summers