File
NCD

Description
The NCD file lists all ICD-9 codes considered medically necessary by Medicare for a particular laboratory CPT or HCPCS code.

What is an NCD?
National Coverage Determinations (NCDs) are nationwide policy statements that apply to all providers submitting to Medicare. The NCDs for clinical laboratory services in particular provide the exact lists of ICD-9 codes that are covered. The clinical laboratory NCDs address approximately one half of all laboratory claims submitted to Medicare. Local Medical Review Policies (LMRPs) cannot conflict with the NCDs and providers must comply with these NCDs for all claims with a date of service on or after November 25, 2002.

3M Health Information Systems Advantage
Most NCDs provide a complete list of all covered ICD-9 codes for each service. However, for some services, the NCD states which ICD-9s are NOT covered instead of the ICD-9’s that are. Because most claim checking systems need the list of covered codes, 3M Health Information Systems' proprietary software generates the "inverse"* of the non-covered list. Because of this advantage, you will never need to alter your software to account for both covered and non-covered ICD-9 lists. We format the data to work in your existing HIS system.

* An "inverse" list contains every single valid ICD-9 code that is NOT listed as non-covered.