How many times has your practice absorbed the cost of a necessary
laboratory test because the specific diagnosis you listed
was not covered? Up until now, there have been no national
guidelines to determine, exactly, when a lab test is covered
or not. Some clinicians have even had to pay outside labs
for their patient's lab bills that weren't covered! (see below).
Recently, CMS published a 200+ page document listing specific
diagnoses and ICD-9-CM codes that regional Medicare carriers
must cover for 23 common tests. We have formatted these
lists for easy lookup by clinicians at the point of care.
STAT NCD Lab Coverage allows the user to quickly scan
diagnosis categories and codes which Medicare will definitely
cover for any of these tests. It uses a format very similar
to STAT ICD-9 Coder and runs on the TealInfo database program.
Recovering payment for even a single lab test will pay for
this software. Now, you never have to wonder exactly when
Medicare will cover a CEA test, for example. Since this
is the first time that these coverage rules have been specifically
determined by consensus, many commercial insurance carriers
are expected to adopt these same rules for their plans.
