Lipid Testing (Clarification of ICD-9-CM Codes for Hypertension)

CMS NCA document | source_status=Closed | review_type=New | public_comment_open=False | document_id=CAG-00188N

CMS has determined that there is sufficient evidence to support including “any disease leading to the formation of atherosclerotic disease” in the list of indications that support coverage for lipid testing. We further determined that benign essential hypertension, as a common precursor to atherosclerotic disease, is an appropriate indication for lipid testing. Accordingly, we intend to modify the NCD list of indications that support coverage of lipid testing as follows: Assessment of patients with atherosclerotic cardiovascular disease Evaluation of primary dyslipidemia Any form of atherosclerotic disease , or any disease leading to the formation of atherosclerotic disease Diagnostic evaluation of diseases associated with altered lipid metabolism, such as: nephroitic syndrome, pancreatitis, hepatic disease, and hypo and hyperthyroidism Secondary dyslipidemia, including diabetes mellitus, disorders of gastrointestinal absorption, chronic renal failure Signs or symptoms of dyslipidemias, such as skin lesions As follow-up to the initial screen for coronary heart disease when total cholesterol is determined to be high or borderline-high plus two or more coronary heart disease risk factors. We also intend to modify the NCD for lipid testing to include code 401.1, benign essential hypertension, in the list of ICD-9-CM codes covered by Medicare for this service. Pursuant to section 1869(f)(1)(B) of the Social Security Act, the term “national coverage determination” means a determination by the Secretary with respect to whether or not a particular item or service is covered nationally under this title [XVIII], but does not include a determination of what code, if any, is assigned to a particular item or service covered under this title or a determination with respect to the amount of payment made for a particular item or service so covered.” Thus, the addition or deletion of the ICD-9-CM codes to given services will not be subject to review under section 1869(f).