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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...

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