LCD - Local Coverage Determination

This option is available to Advanced or Standard subscribers only.

Watch a short YouTube movie and see how easy it is to crosswalk between ICD and CPT using LCD with ICD10Doc.

Since LCD is basically a policy stating which Diagnosis and Procedures are covered in a certain jurisdiction - the LCD is a de-facto crosswalk between ICD and CPT - connecting the ICD diagnosis and procedures to the CPT codes, and vice versa, that are supported by a specific local CMS policy.

1. Find an ICD-9, ICD-10 or CPT code that interests you, with the search or reverse search functions on the Home page. The result will show the relevant LCD in separate boxes as "LCD - supported" or as "LCD - Explicitly NOT supported" together with the state where the LCD is active. Click on the LCD link that you'd like to continue with.



2a. A specific LCD details the CMS policy, CPT, ICD-9 Diagnosis, ICD-10 Diagnosis, ICD-9 Procedures and ICD-10 Procedures that are supported locally by a contractor and thus should be reported as bundled for reimbursement purposes. The medical necessity or justification specified in the LCD must be supported by documenting the right ICD9 or ICD10 diagnosis and / or procedures and the CPT codes.











2b. LCD may explicitly NOT support an ICD diagnosis or procedure and /or CPT code to be reported together. Thus, there's no point in reporting these specific codes as a bundle in a certain state - since there is no clear medical necessity or justification for these codes to be reported together in the LCD - the local contractor may refuse to reimburse them or may ask for additional provider justification.

3. The LCD details the Indications, CMS policy and additional information on the LCD.
On the same page one can find also the contact details of the contractor(s) in charge of the LCD in that state.



Note: Sometimes an ICD code may appear as both supported AND not supported in the same region and within the same LCD... For example, the ICD-10 Diagnosis of: "L23.6 - Allergic contact dermatitis due to food in contact with the skin".
LCD 33261 is supporting the diagnosis L23.6 in Florida, however, on the same page, LCD 33261 is explicitly NOT supporting the same diagnosis in Florida.
While expected that the LCD supporting and the LCD NOT supporting will be mutually exclusive - the reality as reflected in the published CMS tables is not so...

Background

From CMS web site: The term ‘local coverage determination' means a determination by a fiscal intermediary or a carrier under part A or part B, as applicable, respecting whether or not a particular item or service is covered on an intermediary- or carrier-wide basis under such parts, in accordance with section 1862(a)(1)(A).

As a result of the Benefits Improvement and Protection Act of 2000 (BIPA 2000), all Local Medical Review Policies (LMRPs) were converted to LCDs.
The difference between LCDs and previously written LMRPs is that LCDs contain only reasonable and necessary conditions of coverage as allowed under section 1862(a)(1)(A) of the Act. LMRPs may have also contained other information such as coding and payment guidelines. Coding and payment information that is not related to section 1862(a)(1)(A) is not contained in an LCD, Contractors communicate such information in related articles.

For more information on LCD visit CMS web site
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