Certified Revenue Cycle Representative (CRCR) Practice Exam

Medicare guidelines require that when a test is ordered for a LCD or NCD exists, the information provided on the order must include:

1. A valid ICSD code

2. A valid CPT or HCPCS code

3. A physician's signature

4. The patient's medical history

The correct answer is: A valid CPT or HCPCS code

The correct answer is that when a test is ordered and a Local Coverage Determination (LCD) or National Coverage Determination (NCD) exists, the order must include a valid CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) code. This requirement is in place because the CPT or HCPCS codes serve to accurately describe the specific service or test being requested, which is critical for determining coverage eligibility under Medicare guidelines. Providing a valid CPT or HCPCS code ensures that the service can be linked to the appropriate coverage criteria outlined in the LCD or NCD. This specificity helps facilitate the claims process and ensures that the billing aligns with the services rendered. Proper coding is essential for compliance and to avoid claim denials due to insufficient or incorrect information related to the ordered services. While valid ICD (International Classification of Diseases) codes are important for indicating the patient's diagnosis and the medical necessity for the test, they are not specifically required on the order itself in this context. A physician's signature may be important for the legitimacy of the order, but it does not fulfill the specific requirement set forth by the LCD or NCD regarding coding. Lastly, while having a patient’s medical history can be valuable for clinical decision-making, it