Wiki Noridian denial on G0105 with Z86.010

[lynnmunoz]

Is anyone else getting Noridian denials with ICD-10 when you bill G0105 with Z86.010(Personal history of colonic polyps)? All of ours are being denied for "not deemed medically necessary". This is not a frequency problem. We had no problem with getting these paid when G0105 was billed with V12.72 (personal history of colonic polyps). The commercial payers are fine with this ICD-10 coding scenario.

 

[bdobyns]

This NCD rejection is currently being review by Noridian, not no guarantee that it will be overturned to bill like previously done under ICD-10

 

[elaine.pulsepoint@icloud.com]

CMS Confirms Denial

I confirmed with CMS (Michigan Medicare) that their "not medically necessary" denial of G0105 Z86.010 is an invalid error by CMS and that they will release these claims after 1/4/16. The rep I spoke with Friday recommended holding any claims that fit this criteria until after 1/4/16.

Medicare commercial products (BCN advantage, etc) seem to be processing this claim properly.

CMS's clinical editing database is not ICD10 compliant. They have some work to do ....

 

[lynnmunoz]

Here is the response I have received from CMS concerning this issue;

"CMS has identified an issue related to some isolated local interpretation of the NCD for colorectal cancer screening, specifically the coverage of high risk screening colonoscopy. CMS is in action to clarify for local contractors the covered codes and you may work directly with your MAC on next steps for your denied claims. We anticipate our clarification will be available for the MACs in the next week.

Thank you-

ICD-10 Coordination Center"

 

[lynnmunoz]

Noridian has reprocessed all initial claim denials with G0105 and Z86.010(hx of polyps) and has made payment. We had to do nothing on our end. If you are holding claims, I would go ahead a submit them as it looks like they have gotten this problem resolved.