AR2728
Expert
******Disregard-I've been informed the NCD was located--unsure why it was difficult to locate---but all is good and fortunately the patients conditions meet medicall necessity!
We have a patient in need of an abdominal MRA and are having issues verifying medical necessity for the procedure for Medicare. We have searched both WPS and CMS and are unable to locate the specifics on Abdominal MRA coverage. We know for a fact that an NCD/LCD existed for this procedure, and now are unable to locate the information. The patient refuses to have the MRA completed unless we can verify medical necessity with Medicare. He has complex chronic issues with multiple new symptoms and has already completed testing with no known cause located, this is the next step. We contacted Medicare directly to inquiry and they would not provide the information for fear we wanted to just choose a diagnosis that would be covered, clearly not understanding our dilemna and that the NCD at one time was accessible. Our computer system houses the medically necessity tables provided by Medicare and is updated regularly, therefore, when entering the MRA Abdominal procedure code with the patients diagnosis - it continues to alert us to get an ABN signed. Which again, the patient is refusing until we can provide verification that Medicare considers the procedure medically necessary. Has anyone ran into similar issues, or happen to have a copy of an NCD for Abdonminal MRA.
We have a patient in need of an abdominal MRA and are having issues verifying medical necessity for the procedure for Medicare. We have searched both WPS and CMS and are unable to locate the specifics on Abdominal MRA coverage. We know for a fact that an NCD/LCD existed for this procedure, and now are unable to locate the information. The patient refuses to have the MRA completed unless we can verify medical necessity with Medicare. He has complex chronic issues with multiple new symptoms and has already completed testing with no known cause located, this is the next step. We contacted Medicare directly to inquiry and they would not provide the information for fear we wanted to just choose a diagnosis that would be covered, clearly not understanding our dilemna and that the NCD at one time was accessible. Our computer system houses the medically necessity tables provided by Medicare and is updated regularly, therefore, when entering the MRA Abdominal procedure code with the patients diagnosis - it continues to alert us to get an ABN signed. Which again, the patient is refusing until we can provide verification that Medicare considers the procedure medically necessary. Has anyone ran into similar issues, or happen to have a copy of an NCD for Abdonminal MRA.
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