You’re working as a Professional Fee Coder or a Reimbursement Specialist. One of your job requirements is to review charges as they process through the revenue cycle. The attached pdf. has 5 questions. Questions 1-4 will require you to review the LCD -Local Coverage Determination policy on the Medicare website.
Useful FYI—- CGS Administrators, LCC currently processes & pays
Medicare Parts A & B claims for Ohio Medicare beneficiaries.
Commercial payers will often mirror Medicare with some slight
differences. For this assignment, we’ll just be looking at Medicare.
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The following questions were answered using the LCD for Ohio state (see attached).
1. Virtual Colonoscopy (CT Colonography) 74261 or 74262 Verify which diagnosis, which (if any), are considered a medical necessity & would be consider payable by Medicare. (We will assume conditions have been met). The LCD ID# L30300
a. 626.4 b. 557.1 c. 562.13 d. V67.1
Virtual Colonoscopy review was found with LCD ID #31833. (See Attached)
Code 557.1 for chronic vascular insufficiency of intestine, 562.13 for
diverticulitis of colon with hemorrhage, and V67.1 for follow-up
examination following radiotherapy are considered medical necessity.
However, code 626.4 for irregular menses is not covered, as it is not
related to a colon procedure.
2. Neuromuscular Electro-diagnostic Testing, CPT codes 95907. Verify which (if any) diagnosis is considered a medical necessity & would be “considered” payable by Medicare. (We will assume all conditions have been met) (LCD ID# L33249)
a. 354.0 b. 354.1 c. 340 d. 723.0
LCD ID # 33249 specifies that Electromyography studies (CPT 95907) are medically necessary under the following conditions: a) to …
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