Some new ICD-10 codes were inadvertently left out of a recent update of Medicare mammography and breast biopsy policies, causing claims denials. But after discussions with the Texas Medical Association, Novitas Solutions has agreed to make good on these claims in April.
The affected National Coverage Determination (NCD) policies are:
- NCD 220.4, Mammograms, and
- NCD 220.13, Percutaneous Image-Guided Breast Biopsy.
The Centers for Medicare & Medicaid Services (CMS) will correct the policies with its next update, which is scheduled for April 1. But CMS did not require its Medicare contractors to reprocess the denied claims, said Genevieve Davis, TMA associate vice president of payment advocacy. Novitas, the Texas Medicare claims processor, said it will reprocess the claims after the April 1 update.
The claims will continue to deny until April 1, but you’ll receive payment when Novitas automatically reprocesses them. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. Details are on the Novitas website.
If you have questions about Medicare or other payer billing, coding, or policies, contact a TMA reimbursement specialist at paymentadvocacy[at]texmed[dot]org, or call (800) 880-7955.
Last Updated On
February 08, 2018
Originally Published On
February 08, 2018