HI215Unit3DB

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Purdue Global University *

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Course

215

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Medicine

Date

Oct 30, 2023

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docx

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Uploaded by ChancellorScience11272

 The American College of Medical Quality defined medical necessity as “accepted healthcare services and supplies provided by healthcare entities, appropriate to the evaluation and treatment of a disease, condition, illness, or injury and consistent with applicable standard of care” (ACMQ, 2010, p.1).  The details of coverage for this code state that this code was revised and effective on 10/27/2022 for services performed on or after 10/01/2015. The only limitation I can see is that CMS limited how much of the antigen can be prepared at one time for one single patient at a time. The limitation is changed from a 12- week supply to a 12-month supply. It is revised with the stipulation that the physician is responsible for only furnishing a supply that would remain stable and potent over the period for which the treatment is administered.  “Controlled studies have shown that allergen immunotherapy is effective for patients with allergic rhinitis or conjunctivitis, allergic asthma, and stinging insect hypersensitivity,” and is a prime example of possible application for code 200: Allergy Testing and Immunotherapy. However, according to ICD-10, code T78.40 explains it perfectly if it were to be allergy unspecified. CMS Transmittal No. 1770, Publication 100 – 04, Medicare Claims Processing Manual, Change Request #6520, July 10, 2009, Medicare contractor annual update of the international classification of diseases, ninth revision, clinical modification (ICD- 9-CM). Harrington, M. K. (2019). Health Care Finance and the Mechanics of Insurance and Reimbursement (2nd ed.). Jones & Bartlett Learning. https://purdueuniversityglobal.vitalsource.com/books/9781284203 301

Centers for Medicare and Medicaid Services. (n.d.). Local coverage determinations (LCDs) alphabetical index. https://www.cms.gov/medicare-coverage-database/indexes/lcd- alphabetical-index.aspx?DocType=Active&bc=AAIAAAAAAAAAAA %3d%3d&

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