Part B Insider (Multispecialty) Coding Alert
This Payer Identifies Issue with ICD-10 Code Z86.010
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Just one month after the ICD-10 system went into effect, some payers are slowly identifying claims processing issues, and correcting them on the spot to help your claims continue to flow.
Case in point: Cahaba GBA, a Part B MAC, issued an announcement on Nov. 2 indicating that CMS has been inappropriately denying colorectal screening tests billed with G0105 (Colorectal cancer screening; colonoscopy on individual at high risk) and ICD-10 code Z86.010 (Personal history of colonic polyps). The MAC noted that CMS is taking appropriate action to correct the denials “and appropriate payment will be made for these procedures within 45 days.”
Practices don’t need to take any action to get these claims paid, since the insurers will automatically reprocess claims denied for this reason, Cahaba said.
Resource: To read more on this issue, visit www.cahabagba.com/news/colorectal-cancer-screening-claims-processing-issue.
In other news…
When government officials tell doctors not to accept kickbacks, they mean it. That’s the takeaway from a recent case in Massachusetts, in which an ob-gyn is accused of taking free meals and cash in exchange for prescribing specific medications for her patients. The physician also allegedly let the pharmaceutical sales reps review her patient records, according to the Justice Department, which published a news release about the case on Oct. 22.
The doctor is said to have accepted $23,500 in exchange for prescribing certain osteoporosis drugs, and the pharmaceutical company also allegedly paid to cater an event at the doctor’s home. The ob-gyn could face up to five years in prison and substantial fines, the DOJ noted.
Resource: To read more about the case, visit www.justice.gov/usao-ma/pr/springfield-doctor-indicted-anti-kickback-case.
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This Payer Identifies Issue with ICD-10 Code Z86.010
Plus: Massachusetts ob-gyn accused of trading free meals and cash for prescribing medications. Just one [...]