Wiki Ncd 190.31

[KMCFADYEN]

Is anyone having issues with Palmetto GBA denying claims for 84153 with diagnosis R97.20 as of the 10/1/16 ICD-10 update?
The previous medically necessary diagnosis was R97.20 but ICD-10 update added a 5th digit.
GRRRR

 

[hollomanh]

Looks like the update to the NCD file will no occur until January or April 2017 per the CMS website. The new ICDs will be backdated to their effective date, 10/1/16, but they sure make it a pain in the mean time.

"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 2017 and April 2017 quarterly updates. While the implementation dates will be in January and April, 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."

https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html

 

[KMCFADYEN]

Thank you Heather for the very bad news.

Does anyone else have any comments?

My Urology A/R manager is very unhappy!

 

[TammyHF]

Are Urology practice is in the same boat with WPS.

 

[TammyHF]

I got my first payment with R97.20 as the only diagnosis for PSA for WPS Medicare contractor.

 

[turnerdc@gmail.com]

We are having the same issue with Palmetto. So does this mean we will need to go back and refile everything and after what date do we do this?