LMNs and Procedure Codes

Overview:
If you're being asked to provide a procedure code, it may indicate that your claim is being processed through insurance rather than as an HSA/FSA expense. For HSA/FSA claims, the details contained in your LMN are sufficient.

• Procedure Codes vs. IDC/DX Codes:

  • A 5-digit procedure code is typically required when you visit a licensed practitioner for an in-person consultation or treatment.

  • In the context of an LMN for HSA/FSA claims, the IDC code (or DX code) included in your LMN diagnosis provides the necessary diagnostic information.

  • This IDC/DX code is designed to communicate your diagnosis and the medical necessity of the recommended product or service.

• HSA/FSA Reimbursement Requirements:

  • HSA/FSA claims do not require a procedure code because the LMN already documents the medical necessity based on your diagnosis.

  • Your LMN, which includes the IDC/DX code, meets the documentation standards required by most HSA/FSA administrators for reimbursement purposes.

• Insurance vs. HSA/FSA:

  • If a claim is asking for a procedure code, it is likely intended for insurance processing, not HSA/FSA reimbursement.

  • For HSA/FSA submissions, ensure that your claim includes the LMN with its associated IDC/DX code, which should be sufficient for your administrator to verify the medical necessity of your expense.

• Review Your Submission:

  • Confirm that you have submitted your LMN along with the correct IDC/DX code as part of your HSA/FSA claim documentation.

• Clarify with Your Administrator:

  • If your HSA/FSA administrator requests a procedure code, explain that the LMN you provided includes an IDC/DX code, which fulfills the necessary requirements for HSA/FSA claims.

• Use Appropriate Channels:

  • Ensure that you are submitting your claim through the correct channel for HSA/FSA reimbursement, as opposed to an insurance claim, which might require a procedure code.

Your LMN is tailored for HSA/FSA reimbursement and includes the essential diagnostic information (via the IDC/DX code) needed to establish the medical necessity of your expense. The request for a procedure code generally applies to insurance claims rather than HSA/FSA submissions.

If you have any questions or need further assistance with your claim documentation, please contact our support team at support@truemed.com. We're here to help ensure your reimbursement process goes smoothly.