Finding ICD-9 medically necessary for some CPTs

[struk]

Hi, how can I find ICD-9 that determin medical necessity for tests like Holter Monitoring, R/O AAA, Carotid Ultrasound, Pulmonary function test, lower extremity venous duplex, lower extremity arterial duplex for Medicare, for NY state?

 

[Cyndi113]

Look on your Medicare carrier's website for LCDs.

 

[mitchellde]

Actually the dx code you use for the claim can be found in the provider's documentation as to why the test was ordered. You cannot select dx codes from the LCD or NCD. These can help you to determine if an ABN is necessary prior to the procedure. But the dx code you use MUST correspond to the diagnosis documented by the provider as the reason for the test, or in the case of non screening the result found after the study.

 

[Cyndi113]

Excellent answer Debra!!