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Medical Review Frequently Asked Questions (FAQs)

Q1.  What elements need to be present in the Annual Wellness Visits?
A1. There are certain elements that are required for the Annual Wellness Visits. These are discussed in detail in the MLN – ABCs of Annual Wellness Visit (AWV)- https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AWV_chart_ICN905706.pdf This link takes you to an external website..

Q2. Prior to doing Radiofrequency (RF) facet ablations (Procedure codes 64635 and 64636) do you need to do the second diagnostic medial branch block (MBB) injection if the first one provides 100% relief?
A2. Yes, Dual MBBs (a series of two MBBs) are necessary to diagnose facet pain due to an unacceptably high false positive rate of single MBB injections.

Q3. What credentials are required for polysomnography?
A3. The local coverage determination (LCD) policy lists the required credentials for the physician, the technician(s) and the sleep center or laboratory. These credentials should be included in documentation requests from Noridian.

Q4. If documentation is requested for procedure code 27447 Arthroplasty knee, do I need to send an x-ray report if our office has their own x-ray machine and the x-ray is reviewed by the ordering/attending provider?
A4. If the provider indicates in the office note that the x-ray was reviewed and documents what was noted they don't need to dictate an additional report.  The radiographic findings/report need to be supported by pain or functional disability and unsuccessful conservative management to indicate medically necessity for the procedure.

Q5: Why am I receiving a form requesting a contact name for a review of records done on a provider?
A5. Noridian completes medical record reviews and it is important to obtain a contact person to answer questions about missing documentation, and given update on the review findings. More information on Medical Record Review can be found at https://med.noridianmedicare.com/web/jfb/cert-reviews/targeted-probe-educate.

Last Updated Dec 26, 2017