Revision to CMS LCD L33456 for Total Joint replacement on 8/8/16

KMCFADYEN

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Can anyone help me?
I was under the impression that the changes to CMS LCD L33456 for total joint replacement was the addition on ICD-10 codes.
I must be missing something because I have a number of total hips and total knees that are denying for medical necessity due to the revised LCD.
 

KMCFADYEN

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I called Medicare yesterday and was told that my claims were denying due to the LCD and the need for a second diagnosis, but there is nothing in the revision that substantiates this. I believe it is an error and have sent an email to Palmetto GBA (my region's carrier for Medicare) for clarification.
 

alk@APS

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Total Joint denials here too!

We had multiple denials on our total hips and total knees today too. I also printed out the LCD and don't see any indication of a second diagnosis code bee needed. Hope they get this straightened out quickly
 

KMCFADYEN

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This was in the 9/23/16 Palmetto GBA daily newsletter:


LCD L33456 Total Joint Arthroplasty - Incorrect Payments or Denials



Issue:
An issue was identified in the Multi Carrier System (MCS) for claims processed for CPT codes outlined in LCD L33456 (27130, 27132, 27134, 27137, 27138, 27445, 27447, 27486 and 27487). Claims processed from September 6 through September 15, 2016, with dates of service June 16, 2016, through September 15, 2016, may have been incorrectly paid or denied. A workaround was implemented on Thursday Sept 15 to correct the problem.

Provider Action:
No provider action is necessary. Affected claims will be identified and adjusted. This CPIL will be updated once the adjustments have been completed.
 
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