First Coast Service Options will implement a new Local Coverage Determination for Major Joint Replacement on October 16, 2011. The LCD will require physicians to enhance documentation of conservative treatment and indications to support the medical necessity of total hip and total joint replacements in the hospital record in addition to the office based patient record.

The basis of this LCD is the Comprehensive Error Rate Testing (CERT) audits that have called into question the medical necessity of some of these procedures when auditing in-patient hospital records. Due to a lack of documentation of conservative therapy and indications for surgery in some instances the audits have resulted in requests for the hospital and physicians to return compensation for those procedures.

The LCD will require physicians to enhance the documentation they provide in the hospital records. FOS members need to adhere to this LCD to protect their reimbursements.

The FOS worked directly with the AAOS, the Hip and Knee Societies, AAHKS, and First Coast Service Options to make significant changes to the initial proposal. We are pleased that FCSO did make many of the changes that we requested. We do need to hear from you if you discover any issues with the LCD once implemented.

A copy of the Final LCD in effect October 16th is Download Major Joint Replacement LCD Final Version FCSO Full Version.

Also Trailblazers has also weighed in http://www.trailblazerhealth.com/Tools/Notices.aspx?DomainID=1&ID=14756