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CodeMap® 09/29/2006 Medical Necessity Updates

CodeMap Compliance Briefing: 9/29/2006


Editor's Welcome:

Many providers utilize automated systems to screen claims for medical necessity compliance. These systems check the combination of procedure codes and diagnosis codes included with each claim to ensure compliance with both national and local coverage policies. Providers that use these systems must monitor the many changes that occur during the course of a year to CPT® codes, ICD-9 codes, National Coverage Determinations (NCDs), and Local Coverage Determinations (LCDs). If providers do not properly maintain automated compliance checkers, they run the risk of submitting false claims, missing the opportunity to collect an ABN from the beneficiary, and/or receiving denials from their Medicare contractor. This week's briefing focuses on the significant number of changes concerning ICD-9 codes and local and national coverage policies that will take place starting October 1, 2006. As always please email us any comments, suggestions, ....

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