MCCG146 - Week 7 LCD NCD Assignment

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Bryant & Stratton College *

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146

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Mechanical Engineering

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Apr 3, 2024

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MCCG146 – CPT and HCPCS Level II Coding Week 7 LCD/ NCD Assignment This Assessment is worth 10% of your grade. Deadline Due by the end of Week 7 at 11:59 pm, ET. Completing this Assessment will help you to meet the following: Course Outcome  Validate medical necessity using LCD and NCD in provided scenarios. Directions 1. Review the five scenarios below and assign the appropriate HCPCS Level II or CPT code. 2. Visit the Medicare Coverage Database to find and assign the Local Coverage Determination (LCD) /Local Coverage Article (LCA) Article ID or National Coverage Determination (NCD) Manual Section Number associated with the assigned HCPCS Level II or CPT code. After reviewing the LCD/LCA/NCD, determine if the documented service is covered under the determination. Provide rationale as to whether or not the HCPCS Level II or CPT code is covered for the documented reason and if this will meet medical necessity based on the LCD/NCD. Scenario 1 Patient has been recently diagnosed with plantar fasciitis. The provider orders a static foot orthosis. HCPCS Level II code for static foot orthosis, prefabricated, customized for patient: L4397 LCD/LCA Article ID: L33686 State: Indiana Is this covered or non-covered? Covered Rationale: Criterion 5 is met which states if the beneficiary has plantar fasciitis. The patient was diagnosed with plantar fasciitis.

MCCG146 – LCD/NCD Assignment 2 Scenario 2 Morbid obese patient is scheduled to have a laparoscopic sleeve gastrectomy. The patient has been non-compliant with other forms of medical treatment to lose weight, has been diagnosed with bipolar disease, and refuses to quit smoking cigarettes. CPT code for laparoscopic sleeve gastrectomy: 43775 LCD/LCA Article ID: A53026 State: California Is this covered or non-covered? Non-covered Rationale: The patient has not been compliant with medical treatment for weight loss. Scenario 3 Patient has a 0.9 cm benign skin lesion located on her forearm. She does not like the appearance of it and requested it to be removed. When the provider asked about the associated symptoms, the patient indicated that there were none; she just does not like the appearance. CPT code for removal of 0.9 cm benign skin lesion on forearm, simple repair: 11401 LCD/LCA Article ID: A57482 State: Indiana Is this covered or non-covered? Non-covered Rationale: This case would be considered cosmetic. The patient has no associated symptoms requiring removal. Scenario 4 Patient has had fibromyalgia for 2 years. She is requesting trigger point injections of her knotted muscles in her legs (sartorius, semimembranosus, semitendinosus and gastrocnemius) as that is where she experiences most of her pain. CPT code for Trigger Point Injections 20561 LCD/LCA Article ID: State: Colorado NCD Manual Section Number (s) 30.3

MCCG146 – LCD/NCD Assignment 3 Referenced in Article Is this covered or non-covered? Non-covered Rationale: Acupuncture is only covered for chronic low back pain. This patient has expressed pain in her legs. Scenario 5 Patient needs to have treatment of their kidney stones and is scheduled to have a Nephrolithotomy to remove the kidney stones. CPT code for Treatment of Kidney Stones - Nephrolithotomy: 50080 NCD Manual Section Number: 230.1 Is this covered or non-covered? Covered Rationale: Patient is scheduled to have a Nephrolithotomy done to remove the kidney stones.

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MCCG146 – LCD/NCD Assignment 4 MCCG146 – LCD/ NCD Assignment Grading Rubric Criteria Exceeds Expectations Meets Expectations Needs Improvement Points CPT/ HCPCS Level II Code Identificatio n (50 points) 50 points 5/5 of the CPT/HCPCS Level II codes were identified accurately. 40 - 49 points 3-4 of the CPT/HCPCS Level II codes were identified correctly. 0 - 39 points 2 or fewer of the CPT/HCPCS Level II codes were identified correctly. LCD/LCA/NCD Identificatio n (20 points) 20 points 5/5 of the LCD/LCA/NCDs were identified accurately. 15 - 19 points 3-4 of the LCD/LCA/NCDs were identified accurately. 0 - 14 points 2 or fewer of the LCD/LCA/NCDs were identified accurately. Rationale (30 points) 30 points The rationale provided is thorough and the explanation of 5/5 scenarios is accurate. 20 - 29 points The rationale provided is thorough and the explanation of at least 3-4 of the scenarios is accurate. 0 - 19 points The rationale provided is thorough and the explanation of 2 or fewer of the scenarios is accurate. Instructor Comments: Total Points: