×

close

tci Outpatient Facility Coding Alert - 2020 Issue Q1

Reader Question: Know How to Handle LCD Non-Covered Dxs

Question: Does Medicare restrict coverage to only the diagnoses listed under the code’s Local Coverage Determination (LCD)? If so, are you able to appeal in order to argue medical necessity with a non-covered diagnosis? California Subscriber Answer: If you know you are submitting a claim with a diagnosis code that is not covered based on the CPT® code’s LCD, you have a few options in place. First, you should have the patient sign an ABN (advanced beneficiary notice) when performing this procedure with a diagnosis not covered under the LCD. This way, should you not be successful...

To read the full article, sign in and subscribe to tci Outpatient Facility Coding Alert.

Thank you for choosing Find-A-Code, please Sign In to remove ads.