LCD updates: Know what lies in store for you

Author: James Smith

Author: James Smith

Sometimes, you may be bogged down when trying to learn how to code for a particular procedure. CMS has come up with Local Carrier Determinants (LCD), which are great sources of information. But the problem is most practices do not know they exist.

LCDs are developed to define the appropriate use of new technologies, to address services with an abuse history or potential, and the like.

These are contractor-based coverage policies, pertaining to services or items not addressed in National Coverage Determinations (NCD) or program manuals. Created by the Benefit Improvement Protection Act (BIPA) 522, LCDs consist of reasonable and necessary information. And this is what separates it from LMRPs (LCDs consist of only reasonable and necessary information while LMRPs may also contain category or statutory provisions).

LCDs contain coding and utilization guidelines along with descriptive passages. Sometimes it contains CMS languages as well. The final rule establishing LCDs was published on November 11, 2003.

There are various news doing the rounds as far as LCDs are concerned. For instance, in September, we saw CMS issuing new guidance that delegates Medicare contractors the authority to make an exception to clinical criteria described in LCD on a case-by-case basis.

If an unwarranted number of exceptions are made to clinical criteria in a particular LCD, indicating circumstances are not so rare and unusual, contractors have the right to re-evaluate the LCD. Earlier, the only way to get an LCD changed was to go to the Carrier Advisory Committee (CAC) and lay down your case.

LCD will be affected by the 2010 ICD-9-CM updates. As such you need to stay tuned to the latest in this direction. One way of keeping pace with these LCD updates is by signing up for a one-stop coding website, which will give out all the information pertaining to LCDs and other updates. So get going.About the Author:

We provide you simple, instant connection to official code descriptors & guidelines and other tools for CPT coding, HCPCS lookup that help coders and billers to excel in the work they do every day.

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