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Let's Chat About Provider Enrollment Revalidation

Feb 19, 1:00 PM – 2:00 PM EST

NGSConnex New User Orientation

Feb 19, 2:00 PM – 3:30 PM EST

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Feb 20, 12:00 PM – 12:45 PM EST
 
 
 
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Go to All Production Alerts

CPT Code 84153 Has Been Inappropriately Denied



Date Reported

12/31/18

Status

Open

Provider Type(s) Impacted

All Part A and Part B Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

CPT code 84153

Description of Issue

CPT code 84153 which is included in the biomarker testing (prior to initial biopsy) for Prostate Cancer Diagnosis LCD (L37733) has been inappropriately denied as a result of a system issue for dates of service 12/1/2018 through 12/30/2018. The issue has now been corrected.


National Government Services Action

Update 1/7/2019:A mass adjustment is planned for impacted claims but has not yet been initiated.

Update 1/9/2019: Mass adjustment for impacted claims has been delayed and is now expected to be completed in early February. Please continue to monitor this site for further details as they become available.

Update 1/22/2019: CPT 84153 continues to edit on NCD 190.31. Providers are advised to consult the NCD guidelines on this code, rather than the NGS LCD.

Update 02/01/2019: Mass adjustment on denied claims has been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Update 2/4/2019: Adjustments have been completed on impacted claims; the issue is now closed.

Update 2/5/2019: Previous notice of completed adjustments was incorrect; adjustments are now pending initiation. Please continue to monitor this site for notice of completion on the adjustment process.

Update 2/11/2019: Mass adjustment on denied claims have now been initiated. Please continue to monitor this site for a notice indicating completed adjustments.

Provider Action

No provider action is necessary at this time.

Proposed Resolution/Fix

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

We have identified sporadic instances of negative reimbursement on inpatient claims with Demonstration 86, BPCI Advanced SNF Waiver.


Date Reported

1/9/19

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

N/A

Description of Issue

We have identified sporadic instances of negative reimbursement on inpatient claims with Demonstration 86, BPCI Advanced SNF Waiver. A FISS system issue is causing the Value Code Y1-Y4 to be incorrectly added to these claims.

National Government Services Action

We are working with CMS and the FISS maintainer to fix this system issue.

Provider Action

Until a fix is implemented, providers may adjust claims and remove the Y1-Y4 value codes.

Proposed Resolution/Fix

We are working with CMS and the FISS maintainer to fix this system issue. Please continue to monitor the website and email updates for additional updates.

We have identified persistent instances of incorrect denials for these impacted codes (which are included in the Transthoracic Echocardiography [TTE] LCD L33577).


Date Reported

1/10/19

Status

Open

Provider Type(s) Impacted

Jurisdiction 6 and Jurisdiction K Part A Providers

Date Resolved

Reason Code(s)

N/A

Claim Coding Impact

CPT and HCPCS codes 93306, 93307, 93308, C8923, C8924 and C8929

Description of Issue

We have identified persistent instances of incorrect denials for these impacted codes (which are included in the Transthoracic Echocardiography [TTE] LCD L33577). These denials are an ongoing result of an issue with the October ICD-10 code update.

National Government Services Action

We are reviewing the impacted claims.

Provider Action

Please continue to check the Production Alerts section of our website and Email Updates for additional status information.

Proposed Resolution/Fix

1/10/2019: As stated above, a mass adjustment will be initiated once the issue is resolved.

Go to All Upcoming Education

Feb 19

1:00 PM – 2:00 PM EST
Let's Chat About Provider Enrollment Revalidation

Feb 19

2:00 PM – 3:30 PM EST
NGSConnex New User Orientation

Feb 20

12:00 PM – 12:45 PM EST
Wellness Wednesday: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

Feb 21

12:00 PM – 1:00 PM EST
Inpatient Hospital Discharge with Home Health, Hospice or DMEPOS

Feb 21

1:00 PM – 2:00 PM EST
Provider Enrollment: Submitting Revalidations via PECOS
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