Urology 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? Florida 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. 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. Find more about different Medicare coverage types at https://www.cms.gov/medicare-coverage-database.
Urology Coding Alert
- Frequently Asked Questions:
Check Your Urinary Diversion Knowledge With These FAQs
Remember to append modifier 50 where necessary to avoid a denial. There are instances where [...] - CPT®:
Decipher the Symbols in Your CPT® Code Book for Easier Code Selection
These notations can help coders better master each code’s guidelines and descriptors. Every coder who’s [...] - Practice Management:
Study These Strategies for Setting Up a Solid CDI Process
Understand the benefits of regular self-audits. Comprehensive clinical documentation is the cornerstone of quality patient [...] - You Be the Coder:
Decide How to Code This Piggyback Stone Fragmentation
Question: My urologist performed a percutaneous stone removal, with the access being carried out by the [...] - Reader Questions:
Dive Into This Bladder Tumor Scar Scenario
Question: The patient is here for a follow-up transurethral resection of a bladder tumor (TURBT) due [...] - Reader Questions:
Lean on E/M Documentation for Services not Actually Performed
Question: Can we count a provider’s efforts to counsel a patient against a test as evaluation [...] - Reader Questions:
Distinguish NCD From LCD
Question: What’s the difference between a national coverage determination (NCD) and a local coverage determination (LCD), [...]
