Urology Coding Alert

Question: Are other coders receiving denials fora PSA claim after 10/1/2016 for using the new ICD-10 code R97.20?

Kansas Subscriber

Answer: Yes, physicians are getting denials for claims with ICD-10 diagnosis R97.20 (Elevated prostate specific antigen [PSA]).

Here’s why: Medicare’s lab system is not accepting the new diagnosis codes until either January 1 or April 1 of 2017. The new ICD-10 codes will be backdated to their effective date once that shift takes place.

According to the National Coverage Determination, “Please note that due to this being the first regular ICD-10 code update since the partial code freeze October 1, 2011, (there were limited new codes introduced in fiscal years 2012, 2013, 2014, and 2015), and the voluminous number of new codes involved, the Medicare shared systems will split implementation of the new codes over the January 1, 2017 and April1, 2017 quarterly updates. While the implementation dates will be in January 1 and April 1, 2017, the effective dates of the new codes will still be October 1, 2016. All deleted codes will not be valid for payment after September 30, 2016. Contractors will be instructed to adjust claims brought to their attention.”