Wiki Medicare and the new Breast mass ICD 10 code denials

[Coastal Coder]

Good Morning,

I was just wondering if anyone else is getting denials for the new Breast mass diagnosis codes from Medicare.
I am being told they have not updated there system to recognize these new codes.


Thanks,

Michelle English CPC

 

[DKA]

Medicare and Breast Mass ICD 10 code denials

Yes, we have been getting these denials from Medicare and also from the Medicare MCOs. I called the Medicare contractor customer service line (J8 MAC Part B) this afternoon. I was told that the claims are denying based on NCD 220.4. Even though the new breast mass diagnosis codes became effective on 10-1-17, their system is not set up for them and their edits will not be updated to accept the new codes until April 2, 2018. They will NOT do a mass adjustment once the update happens. We will have to call and ask them to reprocess our claims at that time. She said they realize that it will be a major inconvenience and a huge undertaking for the providers so she is pretty sure that we can request reprocessing for multiple ICNs at once instead of having to call separately for each one.

D. Allen CPC