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and the Home of the Series

 

 

Why You Need

(unfortunately)

 

NCDMeister can help you avoid denial of payments for lab tests that don't meet Medicare's definition of medical necessity.

Here's how . . . .

To control costs, Medicare and many other insurers deny payment for tests that they consider "medically unnecessary."  Computers determine if the test you ordered for your patient is "necessary" by comparing the ICD-9 diagnosis code you submitted to a list of approved, payable codes.  These payable codes are listed in a document called the National Coverage Determinations (NCD) which is published and periodically updated by the Centers for Medicare and Medicaid Services.

There are more than 15,000 ICD-9 diagnosis codes out there.  For some tests (like a CBC), thousands of ICD-9 codes may be acceptable and payable.  For other tests, only a handful of ICD-9 codes will be accepted as payable.  For example, a PSA test is payable only if submitted with one of only 27 ICD-9 diagnosis codes.

These NCD rules often seem arbitary and puzzling.  For example, let's say you have a patient with anemia who needs a PT and PTT.  A prothrombin time (PT) is payable if associated with any one of seven ICD-9 codes for anemia but a partial thromboplastin time (PTT) is payable only if associated with just one of those anemia codes.  Double checking that ICD-9 code before submitting the lab request can be the difference between getting paid for a lab test and being stuck paying for it yourself.

The NCD payment restrictions are burdensome.  We shouldn't be happy about this.  It is yet another bureaucratic hassle that steals away the time we have with our patients and whittles away at our diminshing reimbursements.

We shouldn't be happy about it but we can minimize its impact.  Medicare makes a list of these NCD's freely available.  You can review these here.  In creating NCDMeister, we took all of the useful  information from these pages and reformatted it for easy searching and reference on your PDA.

Use NCDMeister to prevent denials of payment by ensuring that the ICD-9 codes you submit with your lab orders are both appropriate and accepted as payable by Medicare and other insurers.

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