1. Q

    Wiki Medicare vs. Medicare Advantage

    Whose coverage guidelines would take precedence between Medicare (MCR) NCD and a Medicare Advantage (MA) clinical policy, where the MA's policy was more restrictive? For example: If MCR guideline allowed for treating a certain condition, but the MA plan's guidelines require additional criteria...
  2. L

    Wiki high risk pap - Medicare

    When we had a pt who was high risk for cervical Ca in ICD-9, Mcr told us to use V15.89 dx code. I'm trying to find the conversion code to ICD-10. I tried using V92.89 which was my coding software's conversion, but Mcr denied it. Does anyone know where to find high risk I-10 code on CMS...
  3. A

    Wiki Physicians Treating Family members

    I've heard before that this is not covered by Medicare, at least in New York State. Does anyone have any links from MCR or any other carriers as to not billing services provided to direct family members? Thanks in advance.
  4. P

    Wiki NEED FAST HELP re; G0105

    Hi all, I'm hoping to get some fast help on this topic as we run into this scenario all the time at our facility and us in coding keep butting heads about the right way to go about it. There does not seem to be clear documentation out there as to when a patient is considered "high risk" allowing...