Update – CMS and Radiological Imaging Claims Issues

NGS Claims System to be Corrected Starting in April, 2018.

According to National Government Services, the Medicare carrier for Connecticut, most of the claims and physicians impacted were in private, non-hospital based settings. CMS has updated several NCDs, but these updates will not be effective within the FISS or the MCS until April, 2018. This alert applies to NCD 220.4 for Diagnostic Mammograms and also NCD 220.13 for Percutaneous Image-Guided Biopsy of the Breast, but other NCDs may be potentially impacted by coding updates. Currently, CMS has issued instructions for A/B MACs to temporarily deactivate the shared system edits associated with NCD 220.4 (Mammograms), and NCD 220.13 (Percutaneous Image-Guided Breast Biopsy) from October 1, 2017 through April 1, 2018. Edits will be reactivated on April 2, 2018. Any erroneously processed claims with dates of service 10/1/2017 through 4/1/2018 (processed on or after 10/1/2017) which contained the ICD-10 codes N63.11 - N63.14, N63.21 - N63.24, N63.31, N63.32, N63.41, N63.42 as the only payable diagnoses on the claims will be reprocessed.

Thanks in part to CSMS advocacy, CMS is changing their processing to be sure all radiology claims are paid without the need to individually appeal each claim originally denied by CMS. Claims will be reprocessed beginning April 2, 2018.