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MUSC Intranet

  Guidelines for Medical Necessity For Limited Coverage Tests





Patient Care Provider Responsibilliites

MUSC Lab Services Responsibilities

What is ABN

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  1. Determine the diagnosis or sign / symptoms of the patient.
  2. Write the diagnosis / ICD-9 code(s) on the lab requisition or electronic system; code to the highest degree of specificity.
  3. Check the Table of Contents for test names to determine if the test requested is listed. If an MUSC Lab Request is utilized, the bolded tests are considered limited coverage. If the test is not listed or bolded, no further action is necessary.
  4. If the test is listed on this webpage or bolded on the lab request, click on the correct test name to be directed to the CMS website for the listing of acceptable ICD9 codes . Review the ICD-9 Code table for the appropriate diagnosis of the patient and document that code on the lab request.
    Note: For Blood Counts, the ICD-9 Code table includes only non-covered ICD-9 codes
  1. If the patient's diagnosis is not listed, inform the patient that payment for this service is likely to be denied and the reason for the denial. If the patient chooses to have the test, he / she must be asked to sign and date the Advance Beneficiary Notice (ABN).
  2. Attach a copy of the completed/signed ABN with the lab request and submit with specimen to MUSC Laboratory.
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