Are Retired NCDs Applicable?

[tlj9536]

We have received a denial on a claim for medical necessity, but the only NCD for the test is retired. Are retired NCDs applicable to tests that have taken place after their retirement date? Please help!

 

[OCD_coder]

Could you include the Dx and CPT codes used on the claim?
You can still have a medical necessity denial even if there is no NCD or LCD. For example: You wouldn't code a CPT 29881 meniscectomy if the Dx was 648.10, kind of silly I know - but you'd be surprised what is on claims sometimes.

 

[cmartin]

I think what I've seen when they're retiring NCDs or LCDs is something to the effect that, while the specific pre-pay edits are being retired, all claims are subject to review for medical necessity, and many of the principles in retired policies are still applicable.