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Thursday, July 22, 2010

How to prevent the denial

Denial Explanation

Claim/service denied because Medicare cannot pay for the diagnosis/diagnoses on the claim. Denied based on a LCD. Provider liable.

How to Prevent These Denials

These are automated denials. LCDs include a list of covered diagnoses. The diagnosis codes on the claim are compared to the procedure code billed to determine if the services are covered by the LCD. When submitting a claim for payment, code all applicable diagnoses on the claim. Include the final diagnosis as well as
signs and symptoms.

Denial Explanation

Claim/service denied per the NCD module because the diagnosis/diagnoses on the claim did not support the medical necessity for the service. Provider liable


These are automated denials. The laboratory NCDs include a list of covered diagnoses. The  diagnosis codes on the claim are compared to the procedure code billed to determine if the services
are covered by the NCD. When submitting a claim for payment, code all applicable diagnoses on the claim. Include the final diagnosis as well as signs and symptoms.

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