Neurosurgery Coding Alert
Distinguish NCD From LCD
Question: What’s the difference between a national coverage determination (NCD) and a local coverage determination (LCD), besides the obvious difference in scope? Nevada Subscriber Answer: One big difference between NCDs and LCDs is the way that they’re developed. According to the Centers for Medicare & Medicaid Services (CMS), LCDs are developed by Medicare Administrative Contractors (MACs), and NCDs are established by CMS. In a document about Medicare Coverage Type Descriptions, CMS says LCDs are decisions made by MACs “on whether a particular service or item is reasonable and necessary, and therefore covered by Medicare within the specific jurisdiction that the MAC oversees. … LCDs outline how the contractor will review claims to ensure that the services provided meet Medicare coverage requirements. Before an LCD becomes final, the MAC publishes Proposed LCDs, which include a public comment period.” MACs develop LCDs for a topic or service in the absence of an NCD. More than one MAC may manage services based on a single LCD criteria. LCDs can differ between MACs, which means an LCD may really be local. Therefore, it’s important to check with your MAC’s determinations directly to make sure you’re in compliance. CMS describes NCDs as national policies developed and released by CMS establishing the Medicare coverage for specific medical items or services across all states. MACs are required to follow NCDs, and NCDs trump LCDs. There won’t be any difference in determinations between jurisdictions, because the coverage is national. Check out the CMS website for more about different Medicare coverage types.
Neurosurgery Coding Alert
- Surgery:
Know Area Before Coding Neurostimulator Arrays
A trio of code sets represents these surgeries. Patients requiring open neurostimulator electrode array placement [...] - Medicare Physician Fee Schedule:
Here’s the Big News in the 2025 Proposed Rule
Big surprise: Another rate cut is coming. The Centers for Medicare & Medicaid Services (CMS) [...] - Modifier Madness:
Append Assistant at Surgery Modifiers Correctly
Hint: Do not report modifiers 80 and AS together. Modifiers are important to your medical [...] - You Be the Coder:
Electrothermal Annuloplasty
Question: A patient with lumbar spondylolysis reports to the surgeon for percutaneous intradiscal electrothermal annuloplasty. Under [...] - Reader Questions:
Use This Code for Lumbar Stenosis Tx
Question: Encounter notes indicates that the surgeon performed a laminectomy with exploration of the cauda equina [...] - Reader Questions:
Phone In This E/M Encounter
Question: A patient presented to the office for a follow-up appointment. When the patient arrived, they [...] - Reader Questions:
Select This Dx for Pick’s Disease
Question: Encounter notes indicate that a patient suffers from primary progressive aphasia. I can’t find this [...] - Reader Questions:
Get the Skinny on Medicare Overpayment Timeline
Question: We’ve heard that Centers for Medicare & Medicaid Services (CMS) says we should return any [...] - Reader Questions:
Distinguish NCD From LCD
Question: What’s the difference between a national coverage determination (NCD) and a local coverage determination (LCD), [...]
