2015-11-03 16:39:44 UTC

AGA Works with CMS to Fix ICD-10 Screening Colonoscopy Error

Nov. 3, 2015

AGA will continue working with the agency to ensure claims are processed correctly.

By Nov. 12, CMS will issue updated edits to Medicare Administrative Contractors (MACs) instructing them to allow colonoscopy screening code G0105 to be reported with ICD-10 code Z86.010. CMS has already updated the ICD-10 listing for National Coverage Decision (NCD) 210.3, Colorectal Cancer Screening TestsThanks to the help of the many AGA members and their staff who alerted us to the problem and provided redacted claims, AGA was able to work with the CMS ICD-10 Ombudsman and CMS deputy administrator toward a quick resolution. 

CMS will then make a mass adjustment to claims that have been denied in error. It is unnecessary to resubmit the claim or to request an appeal; no provider action is needed. MACs will need to complete the reprocessing of all denied claims within 45 days, and some have already started

In mid-October, AGA received reports that some Medicare contractors were rejecting the specific colonoscopy screening codeG0105 (Colorectal cancer screening; colonoscopy on individual at high risk) when submitted with ICD-10 code Z86.010 (Personal history of colonic polyps). 

AGA, together with ASGE and ACG, met with Sean Cavanaugh, the deputy administrator and director of CMS, and alerted him to this issue. We also worked with CMS ICD-10 Ombudsman who was instrumental in investigating the issue and enacting a solution. 

Are you experiencing ICD-10 implementation issues? Please contact Leslie Narramore, director of reimbursement, AGA Institute.

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