NCD and LMRP ‘Find’ Feature.

With the addition of NCDs (National Coverage Determination) we now must display codes that are affected by national bulletins (NCDs) as well as the codes affected at the regional level by LMRPs (Local Medical Review Policies).

We are doing this by continuing to display an active ABN (Advanced Beneficiary Notification) button when a service code is affected by either a NCD or LRMP, or both.

Note that code 80061 has an active ABN button as displayed here:

By clicking this button, you will be taken to view any ICD code that would justify medical necessity. This includes all ICD codes---even when multiple LMRPs and NCDs apply to this code.

FIND FEATURE, Non-Existing ICD code: You can enter an ICD code and find whether or not that code is listed in the NCD or LMRP bulletins. An invalid ICD will trigger the following response:



FIND FEATURE, ICD code not in ABN list: An existing ICD code that does not appear on the list will trigger this dialog box:



VALID FINDS:

Any code represented in the NCDs and LMRPs, including its parent codes---all the way back to the 3 digit category code will be 'findable' in the medical necessity code list. Once found, the red and green lights we use in the ICD section will be displayed next to the code to indicate whether it is specific enough for billing. See figure below:



DISCUSSION:

This is an emerging area of program development. We would appreciate any feedback and feature requests for this area of the program.

Code 250 is a parent code to 5th digit codes that do justify medical necessity codes. It will be found as part of the list. However, it is a nonspecific code (green light---in ICD codes the user must go the the next level of detail for more specific codes).

We believe this area of Flash Code will be used in two ways:
1. Users in lab facilities will key in a procedure code, then view the ABN list to see if the accompanying ICD code is included as a medical necessity code. If not, the patient will be prompted to sign an ABN form. Users of this feature must understand that in cases where a code is found, but also has a green light next to it, they will need to communicate with the ordering provider to get additional detail (4th or 5th digit) for the ICD code.

2. Providers may wish to key in a 3 digit category code, assuming the category code is included in the medical necessity list, the user would then be presented with a listing of all 4th and 5th digit codes within the list that applies. In the above example, code 250-Diabetes mellitus, the Find will open a new box that displays the medical necessity codes for 250 at the 4th and 5th digit level. This way the provider will be able to quickly find specific medical necessity codes, by starting with a 3 digit category code.