How is the LMRP Tool used?
On the display are the lab (in green) and radiology (in yellow) services for which medical necessity criteria are required. Select the procedure which you are inquiring about. Enter a word or abbreviation or an ICD-9 code into the search field. Click on Submit. The result lists all ICD-9 codes and their brief descriptions which match the word or code you entered and which meet medical necessity requirements. You may use one or more of these codes on the requisition IF they apply accurately to the patient.

No match was found, or the codes found do not apply to my patient
Try searching with a different word or words. Try using the search option "Any words" instead of "All words" if your search involves more than one word. Alternatively, you may clear the search field and click "Submit". All medical necessity ICD-9 codes for that procedure will be displayed, and you may scroll through them to look for codes appropriate to your patient.

No medical necessity ICD-9 code found applies to my patient but I believe the procedure is necessary
In this case an Advance Beneficiary Notice (ABN) must be created, printed, and signed by the patient. This document should be attached to the lab or radiology requisition.

How do I create an ABN?
When a search is done for a procedure a button appears at the bottom of the screen "Display ABN". Click here to create an ABN which includes the procedure description and expected cost. This page can now be printed. If another procedure is being ordered you may instead click on "Check Another Procedure" at the bottom of the ABN. If the patient's primary language is Spanish you may click on "Spanish ABN".

Why is Noyes making this tool available?
Medicare has refused payment for many ordered procedures because the requisitions do not include a diagnosis code (ICD-9) that meets medical necessity criteria. In our region these criteria are set by Empire Medicare, a fiscal intermediary contracting with Medicare.

In order to comply with medical necessity requirements and avoid further loss of revenue, Noyes will require lab and X-ray requisitions to include ICD-9 codes. This LMRP Tool provides a look-up utility to enable physicians, other providers, and office staff, to find appropriate codes that reflect the patients' diagnoses and that meet medical necessity requirements.

Must the LMRP Tool be used every time a requisition is completed?
No, this tool, like any coding tool such as a CPT code book, is for convenience. However, if requisitions do not include a diagnosis code meeting medical necessity criteria, Noyes will inform the patient prior to performance of the procedure that they will likely be billed for the test. At that point some patients might chose to not procede with the test as ordered. Using the LMRP Tool will help reduce such occurances to a minimum.

Where does the data for the LMRP Tool come from?
The data is extracted from Empire Medicare's web site. It is updated at least quarterly.

Many lab and X-ray tests are not on the LMRP Tool. Why?
Medicare does not currently require medical necessity criteria for all tests. The LMRP Tool lists the tests commonly performed at Noyes for which medical necessity criteria have been specified by Empire Medicare.

What is an Advance Beneficiary Notice?
An Advance Benificiary Notice (ABN) documents notification to the patient that the ordered service is not likely to be covered by Medicare. The ABN includes the reason why the procedure won't be covered, the estimated cost to the patient, and provides for documentation of the patient's decision to decline or procede with the ordered service. An ABN is required by Medicare regulations if the provider is going to bill the patient for non-covered services.