147 CASE STUDIES IN HEALTH INFORMATION MANAGEMENT CASE 2-38 Local Care Determina
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Question
147 CASE STUDIES IN HEALTH INFORMATION MANAGEMENT CASE 2-38 Local Care Determination (LCD) are a compliance coordinator. Part of your job is to assist the admissions clerk in determining if will cover services ordered or if an advanced beneficiary notice needs to be given. You are Medicare a table for the admission clerks to cros-reference when admitting patients To accomplish this, look up the local care determination (LCD) for each procedure identified in ble 225, fill in the table with the information you find. LCDs can be found online at htp://www.cms hhsg gow. You can also find a direct link to LCDs in the web links section of the student companion webnite. If there are multiple LCDs, use the first one listed. Table 2-23 Local Care Deiensination (LCD Local Care Determination (LCD) LCD Number Limitations Last Date Medicare Coverage?(Summarize) Reviewed Procedure Debridement of mycotic nails B-scan Sleep disorders testing Blood glucose testing Skin substitutes Walkers Nail avulsion Group psychotherapy 2014 Cengnge Leg Rights ReseeExplanation / Answer
Local care determination:
Blepharoplasty:
Medicare coverage:
Blepharoplasty,brow ptosis repair and upper eyelid blepharoptosis repair(CPT codes 15820,15821,15822,15823,67900,67901,67902,67903,67904,67906,67908 and 67909.
Ectropion/entropion repair and lid retraction(CPT codes 67911,67914,67915,67916,67917,67921,67922 and 67924)
canthus repair and lid repair and floppy eyelid syndrome repair(CPT codes 21280,21282,67950,67961 and 67966)
Limitation:
Medicare does not have a national coverage determination(NCD) for blepharoplasty..
Last of reviewed: 01/16/2018
LCD number: B-002
Debridement of mycotic nails:
Medicare coverage:
Payment possible for routine foot care under medicare's national exceptions to routine foot care exclusions onychomycosis may present as one or more nail findings including hypertrophy,lysis,discolouration,brittleness of the nail plate..fungal disease of the toenails,mycotic nail infections..debridement will be cover by medicare coverage when clinical findings are strongly supportive of the diagnosis..it will cover recurrent nail disease,unsucessful treatment with FDA approved antifungal medications..long term beyond 12debridement per 24months etc..medicare will cover pharmacologic treatment with a prescription antifungal agent..
Limitation:
Debridment of mycotic nails to soften the nails or the skin is not eligible for seperate reimbursement
Last date reviewed: 10/01/2015
LCD number: L35013
B-scan:
Medicare coverage:
B-scan implies a two-dimensional ultrasonic scaning procedure with two-dimensional display..AB-scan is done for the purpose of evaluating the interior of the eye..payment will be allowed only for services which are medically reasonable and necessary for the patient's condition..
Limitation:
coverage is not possible for complete absence of all bill type and the policy
Last date reviewed: 10/01/2017
LCD number: L 33904
Sleep disorder test:
Medicare coverage:
Polysomnography is the continuous measurement and recording of physiological activities during sleep..testing is covered when performed by an independent diagnostic testing facility for sleep disorder..some diagnostic or therapeutic facilites that are provided by these facilites may be covered under medicare..physical examination,lab test should be done to confirm the diagnosis..
Limitation:
Diagnostic testing that is duplicative of previous testing done by the attending physician to the extent the result are still pertinent is not covered because it is not reseanable and necessary..
Last date reviewed: 03/10/2011
LCD number: L 28292
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