CMS provider rep confirmed this past Friday that the high risk screening colonoscopy due to personal history of polyps will deny for "not medically necessary" (G0105 Z86.010).
Per the rep, we are coding it correctly, but CMS will not release these claims for payment until AFTER 1/4/2016. Per the rep, she recommends we hold off billing any high risk screenings until after this date.
She did not state the reason, however, it seems pretty clear that the clinical editing database was not accurately or completely updated with the ICD10 code set.
Side note: It appears as if the commercial Medicare products are managing the above scenario and paying the claims.
Per the rep, we are coding it correctly, but CMS will not release these claims for payment until AFTER 1/4/2016. Per the rep, she recommends we hold off billing any high risk screenings until after this date.
She did not state the reason, however, it seems pretty clear that the clinical editing database was not accurately or completely updated with the ICD10 code set.
Side note: It appears as if the commercial Medicare products are managing the above scenario and paying the claims.