Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?

June 4th, 2018 - BC Advantage
Categories:   Diagnosis Coding   Obstetrics|Gynecology   Oncology|Hematology   Claims   Medicare  
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When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out.
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.
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.
CMS has instructed MACs to adjust any claims brought to their attention that were processed in error for any of the NCDs included in CR 10318. These adjustments will not take place until after April 2, 2018 unless otherwise noted.
National Government Services (NGS) has already updated their system and will reprocess claims upon the providers request.

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