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Friday Compliance Briefing: Medical Necessity Requirements for Chemistry Panels

Editor's Welcome:

This week's briefing is in response to the concerns and questions of several of our subscribers. If you keep the questions coming, we will do our best to incoporate them into future Friday Compliance Briefings. Happy Valentine's Day.

Sincerely,

Charles B. Root, Ph.D.

Medical Necessity Requirements for Chemistry Panels

Over the past few weeks, several subscribers have asked how to handle situations where one test in a chemistry panel is not medically necessary because the diagnosis code provided is not included in the National Coverage Determination (NCD)'s list of covered ICD-9 codes.

For example, a renal function panel, which includes glucose, is ordered with diagnosis code 593.9 (unspecified disorder of kidney or ureter). This ICD-9 code is not listed as a covered diagnosis in the NCD for glucose. If a renal function panel (CPT 80069) is billed to Medicare, the Carrier will pay $12.13 even though the glucose test contained in ....

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