swansonjm
New
I'm getting a claim kicked back that Medicare isn't covering 87506 for R19.7 But I'm having trouble finding what ICD 10 code will cover 87506. Any help?
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Wiki 87506 not covered with R19.7 or R11.10
- Thread starter swansonjm
- Start date
Refer to the Medicare LCD. You can search the Medicare Coverage Database by CPT code and state. Entering the correct state is key, to make sure you're looking at the right MAC's LCD.
CMS Medicare Coverage Database link: https://www.cms.gov/medicare-coverage-database/search.aspx
(It should go without saying, of course, that all diagnoses must be supported in the medical record. You can't add ICD-10 codes just to get something paid.)
If NGS is your MAC, here's an excerpt from the NGS LCD. That test will require 2 diagnosis codes - the R19.7 is a Group 1 code in the LCD. There must also be a Group 2 code on the claim, as well as meeting the POS and specialty restrictions listed in the LCD.
Article - Billing and Coding: Multiplex Gastrointestinal Pathogen Panel (GPP) Tests for Acute Gastroenteritis (AGE) (A58963)
Use this page to view details for the Local Coverage Article for billing and coding: multiplex gastrointestinal pathogen panel (gpp) tests for acute gastroenteritis (age).
www.cms.gov
Group 2
(2 Codes) >> Includes 87506Group 2 Paragraph
Highly Multiplexed GPPs- Group 2 Codes
Must be billed in POS 20, 21, 22, 23, or 81 (Urgent Care, Inpatient Hospital, Outpatient Hospital (observation), or Emergency Room), or in POS 81 (Independent Laboratory) in the case of a pre-transplant evaluation for an immune-compromised beneficiary.
Outside of one of these POS, a clinician specialist in one of the following: Infectious Diseases (44), Gastroenterology (10), Oncology (83,90,91), or Transplant must either order the test or communicate with the treating and ordering physician as to appropriate test and interpretation.
The specialist communication must be documented in the medical record.
Group 2
(196 Codes)Group 2 Paragraph
These are the diagnosis codes corresponding to coverage of CPT Group 2 codes- Highly Multiplexed GPPs. One of these diagnosis codes must be on the claim in addition to the sign or symptom for which there is suspicion of gastrointestinal illness (Group 1 code).
(Look to the LCD for the codes - there are 196 codes, so I'm not pasting the full list here.)
swansonjm
New
Thank you so much! I couldn't find where to cross reference the dx