Medicare Coverage Policies for Vascular Surgeons

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Question:

My coder mentioned following an “LCD”. What is an LCD and how does it apply to vascular surgery?

Answer:

LCD is an acronym for Local Coverage Decision (or Determination). An LCD outlines Medicare’s coverage policy for a specific procedure or service. Most Medicare carriers have an LCD for varicose vein surgery, non-invasive imaging, wound therapy and other procedures specific to vascular surgery. An LCD describes the criteria that must be met for the procedure to be covered (paid for) by Medicare. Documentation requirements and required diagnosis codes are typically part of an LCD. Criteria in these LCDs must be closely followed in order for a procedure to be considered medically necessary. Non-compliance with an LCD is a major audit target for Medicare and can result in significant re-payment demands.