Wiki Is Medicare not accepting G0105 anymore?

[patdow]

We’ve been receiving denials from Medicare for CPT code G0105. One of the rejections stated Per LCD or NCD guidelines, procedure code G0105 has not met the associated Diagnosis Code relationship criteria for CMS ID(s) 210.3.

Due to the denials, there has been a questioning if Medicare has discontinued CPT code G0105. On one of the denials, G0105 was changed to G0121 and it was accepted. Additionally, the denials tend to happen on invoices where Z86.0100 is used.

 

[rwiggins]

The problem is the unspecified code.
Z86.0100 Personal history of colon polyps, unspecified
Z86.0101: Personal history of adenomatous and serrated colon polyps
Z78.0102: Personal history of hyperplastic colon polyps
Z86.0109: Personal history of other colon polyps

 

[patdow]

The problem is the unspecified code.
Z86.0100 Personal history of colon polyps, unspecified
Z86.0101: Personal history of adenomatous and serrated colon polyps
Z78.0102: Personal history of hyperplastic colon polyps
Z86.0109: Personal history of other colon polyps

Thank you. Do you know why Medicare would sometimes pay for Z86.0100 and sometimes it doesn’t?

 

[joycelyncross@gmail.com]

Our office is also experiencing this issue, and it's very frustrating. I'm not sure how to proceed, there even denying Z86.0101. Our denials are starting to get out of hand. Typically Medicare resolves these types of issues pretty quickly, but it does not appear to be the case. If anyone has any suggestions it would be greatly appreciated.

 

[whit17]

The problem is the unspecified code.
Z86.0100 Personal history of colon polyps, unspecified
Z86.0101: Personal history of adenomatous and serrated colon polyps
Z78.0102: Personal history of hyperplastic colon polyps
Z86.0109: Personal history of other colon polyps

Hello. I am newer, so please forgive my ignorance, but why would Z86.0100 be an issue if it is a covered diagnosis?

 

[etwomey]

Our office is also experiencing this issue, and it's very frustrating. I'm not sure how to proceed, there even denying Z86.0101. Our denials are starting to get out of hand. Typically Medicare resolves these types of issues pretty quickly, but it does not appear to be the case. If anyone has any suggestions it would be greatly appreciated.

We are having the same issue. They keep denying Z86.0101 with G0105. We were told by a rep that CMS has not updated their system with the new history of polyps codes, and they weren't sure when it would happen. The denials are starting to take up a good chunk of our A/R. It's so frustrating.

 

[TThivierge]

We are having the same issue. They keep denying Z86.0101 with G0105. We were told by a rep that CMS has not updated their system with the new history of polyps codes, and they weren't sure when it would happen. The denials are starting to take up a good chunk of our A/R. It's so frustrating.

Hello All
I hope dx Z86 is the LAST dx code not first.
Lady T

 

[samanthamcknight]

CMS is aware of a glitch when the Z86.010 code was expanded. We were told it would be sometime in April that those claims would get reprocessed by our MCR MAC. Hope that helps in the meantime it is a pain!