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At the end of an LMRP it says: Diagnoses that Support N/A and Diagnoses that DO

Joseph Posted Tue 25th of June, 2013 05:09:32 AM

At the end of an LCD example: "L32754 - Non Invasive Vascular Studies Non Invasive Vascular Studies" it states:

Diagnoses that Support: N/A

and

Diagnoses that DO NOT Support Medical Necessity: N/A

Example website: https://www.novitas-solutions.com/policy/jh/l32754-r6.html Its near the end and after the section that lists all the icd9's that will work.

Can someone tell me what that section means? Does that mean that ANY icd9 code will or will not work?

SuperCoder Answered Tue 25th of June, 2013 21:33:11 PM

We can’t speak for Novitas, but most likely the sections you mention are in the policy as part of a template so Novitas policies have a consistent look. They then fit data into the template as appropriate for that policy. Novitas likely just filled in N/A (not applicable) to indicate there was no policy info in those sections.

In the link you offered, the policy focuses on “ICD-9 Codes that Support Medical Necessity” and then states specifically which ICD-9 codes will show support for specified CPT codes. The claim will be checked against the code pairings in the “ICD-9 Codes that Support Medical Necessity” section. So the other sections are NOT saying ANY code or dx will work.

Novitas opted not to define “Diagnoses that support medical necessity” for this policy. They also opted not to define the ICD-9 codes and diagnoses that do NOT support medical necessity, perhaps because the section on supporting ICD-9 codes is so thorough.

As a comparison, you can see how they offer additional details in those sections for the AICD policy: https://www.novitas-solutions.com/policy/jh/l32617-r5.html.

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