[Jamie Hagan]

I think I know the answer to this but want to bounce it off others prior to telling the patient what I think.
Patient wants a hospital bed soley for the diagnosis of suffering from Seizures and doesn't want to fall out of bed. I don't see how this only will cover this since the actual need does not require the head elevation pain relief etc... and I'm leaning towards telling her that she needs to pay out of pocket for rails on her standard bed since Medicare will not cover on this diagnosis alone for a bed. Does that sound correct?

[HEATHER]

If the patient doesn't meet the coverage criteria listed in the LCD - which doesn't sound like she does - then you can't use the KX modifier. I think you are exactly correct... You could do it unassigned w/ GA mod/ABN or suggest the alternative you mentioned.

[Lorna]

I have just lost my biller and unfortunately she left me with a mess. Can someone please help me with the LCD's etc. for the requirements for a semi-electric bed. Where are all the best places to do research for these items?

[HEATHER]

First is National Coverage Determination - 2nd is Local (we are in FL)

National Coverage Determination (NCD) for Hospital Beds (280.7)

License For Use Of Physicians? Current Procedural Terminology, Fourth edition (?CPT?)

Link to policy article is at the bottom of second link listed above.