Wiki 77066 and G0279 Medicare denied for NCD

mfournier

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Hello Everyone:

We billed for G0279/TC and 77066/TC with dx C50911. Patient is currently receiving treatment. The G0279/TC was paid but the 77066/TC denied for NCD. When reading the article states that it will reimbursed when patient has personal history of breast cancer. So, is it appropriate to report Z85.3 for both procedure codes?

Thanks in advance
Have a nice weekend
 
Hello Everyone:

We billed for G0279/TC and 77066/TC with dx C50911. Patient is currently receiving treatment. The G0279/TC was paid but the 77066/TC denied for NCD. When reading the article states that it will reimbursed when patient has personal history of breast cancer. So, is it appropriate to report Z85.3 for both procedure codes?

Thanks in advance
Have a nice weekend

If the patient has breast cancer in active treatment, it is not appropriate to bill Z85.3

Z85.3 is used when there is no current treatment for the condition and no evidence of the disease.

I'd consider using a more specific breast cancer code. C50.911 is likely getting some push back because it is an unspecified diagnosis.
 
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