Practice Quiz

Medical Coding

Category - Compliance and Regulatory

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What do NCD/LCDs specify?
  1. They specify under which clinical circumstances a service can be considered reasonable and necessary
  2. They specify what codes are unreasonable or unnecessary for every specialty and how much will be reimbursed for something that isn’t reasonable or necessary
  3. They specify benefit categories and exclusions for reimbursement
  4. They specify codes that have been decided to be too high cost or too experimental and that will never be covered by the insurance
Explanation
Answer: A - NCD/LCDs specify the specific circumstances necessary to consider a specific service reasonable and necessary.
The NCD/LCDs do not specify unreasonable or unnecessary codes and are not all inclusive. Any codes part of NCD/LCD can be reconsidered, so certain circumstance may be covered. Local medical review policies (LMRPs) specify benefit categories and exclusionary provisions.
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