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Reader Question: Appeal for Payment if LCD Support Spirometry Diagnosis

Posted on 27. May, 2015 by in Coding Challenge

Question:My records indicate that spirometry is a coverable CMS expense, but we cannot get Medicare to reimburse for it. The denials state that COPD/pulmonary dysfunction and chronic bronchitis are not coverable. My CMS sheet states that is exactly what the test is covered for. What should we do? 

Colorado Subscriber

Answer: When you say “CMS sheet,” we assume you mean the LCD (local coverage determination) for your carrier. That’s what you need to refer to in terms of a procedure’s medical necessity. If your LCD states that your diagnoses (such as 496.x, Chronic airway obstruction, not elsewhere classified, or 491.x, Chronic bronchitis) are covered, include a copy of that information when you appeal the non-payment.

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