What is an NCD?

Before diving into the tool, it’s crucial to understand what NCD stands for. NCD stands for National Coverage Determination—a decision by CMS (Centers for Medicare & Medicaid Services) about whether a particular medical item or service is covered under Medicare nationwide.

When you use NCD Lookup tools, you're essentially checking whether Medicare will reimburse a specific service or procedure based on federal guidelines.

Why Use the NCD Lookup Widget in Codify?

Codify by AAPC is one of the most respected medical coding tools in the industry. The NCD Lookup Widget is a valuable feature for:

• Quickly accessing CMS coverage rules.
• Reducing claim denials.
• Improving coding accuracy.
• Ensuring services meet Medicare documentation requirements.

By integrating this widget into daily workflows, Shoreline Medical Billing Company coders minimize errors and keep denial rates low for healthcare providers.

Step-by-Step: How to Use the NCD Lookup Widget in Codify

Step 1: Log in to Codify

Begin by logging in to your Codify account via AAPC. If you don’t already have an account, you’ll need to register and subscribe to gain access to full functionality, including the NCD tools.

Step 2: Locate the NCD Lookup Widget

Once logged in, navigate to your Codify dashboard. The NCD Lookup Widget is often found under the “Widgets” section or through the “Tools” dropdown menu. You can also search “NCD Lookup” using the internal search bar.

Step 3: Enter the Procedure or Diagnosis Code

In the widget, enter the HCPCS Level II or CPT® code for the procedure or the ICD-10 code for the diagnosis. For example, entering "33208" (for insertion of a pacemaker) will prompt Codify to display Medicare’s national policy on that service.

Alternatively, you can enter a keyword (e.g., "pacemaker") and choose from the results.

Step 4: Review the NCD Details

The widget will generate a comprehensive view of the CMS coverage policy, including:

• Coverage status (Covered, Not Covered, or Limited Coverage)
• Associated ICD-10 codes that support medical necessity
• Documentation guidelines
• Effective dates of the policy

This step is crucial for confirming if a procedure is billable under Medicare guidelines.

Step 5: Cross-Reference with LCDs

In many cases, Local Coverage Determinations (LCDs) complement or add specificity to NCDs. Codify conveniently provides cross-references to related LCDs when available. While NCDs apply nationally, LCDs vary by Medicare Administrative Contractor (MAC), so make sure you’re viewing the relevant region.

At Shoreline Medical Billing Company, our specialists often review both NCD and LCD policies to ensure a holistic understanding of CMS coverage rules before finalizing any billing.

Step 6: Save or Print Policy Information

Codify allows users to print or save the NCD policy details as PDFs. This is useful for sharing with providers, adding to patient records, or documenting justification in appeals or audits.

Step 7: Apply the Information to Your Claim

Armed with this information, you can now confidently assign appropriate diagnosis and procedure codes, ensuring that the claim meets CMS documentation requirements. This significantly reduces the chance of denials due to incorrect or unsupported codes.

Tips for Maximizing the NCD Lookup Tool

1. Use the Tool Daily

Make it a habit to run a NCD Lookup before submitting claims, especially for procedures with known coverage limits.

2. Stay Updated

NCDs are periodically updated by CMS. Codify updates its databases regularly, but it’s wise to double-check the “Effective Date” listed in the widget.

3. Train Your Team

At Shoreline Medical Billing Company, all coders and billers receive formal training on using Codify’s tools, including the NCD widget. This standardizes workflows and minimizes discrepancies.

4. Bookmark Frequent Lookups

Codify allows users to bookmark frequently used codes and policies for quick access. This is especially helpful in high-volume specialties like cardiology or oncology.

Benefits for Billing & Coding Professionals

Using the NCD Lookup Widget in Codify is not just about compliance—it’s about efficiency, reliability, and professionalism. Here’s how it helps:

• Prevents Denials: By confirming coverage in advance, you reduce the risk of claim rejections.
• Improves Coding Accuracy: You can match the correct codes to Medicare policies, minimizing coding errors.
• Boosts Confidence: Whether you’re a seasoned coder or a new billing specialist, knowing you're aligned with CMS policies brings peace of mind.

At Shoreline Medical Billing Company, our commitment to quality hinges on these principles. We trust Codify’s tools to keep us sharp and audit-ready.

Who Should Use the NCD Lookup Widget?

This widget is ideal for:

• Medical coders and billers
• Revenue cycle managers
• Medical practice administrators
• Compliance officers
• Clinical documentation specialists

Even physicians can benefit from reviewing NCDs, especially when determining if a service they plan to offer will be reimbursed by Medicare.