Wiki Denied CT scan

[mercyolson]

Medicare denied a service for a CT Scan of the head. This patient suffered a gun shot wound to the face. The denial states an (LCD) or local coverage determination was used for the claim.

Can someone explain what this means ?

Thank you !

 

[jackjones62]

Well the word OUTRAGE comes to mind, but than again you are dealing with Medicare. Have you looked up the LCD on the CMS website? The LCD is the determination for coverage for certain services. In order for Medicare to pay specific criteria must be met and the LCD explains what those are as well as provide guidelines, including what diagnosis are acceptable/payable. It sounds like it is certainly an appealable situation, frustrating to say the least.

Jennifer
Coding Analyst