The Centers for Medicare & Medicaid (CMS) recently issued instructions that address the holding of mammography claims which reflect computer-aided detection (CAD) device Health Care Common Procedure Coding System (HCPCS) Codes (G0236 or 76085).
A joint signature memorandum issued on April 4, 2003 has advised fiscal intermediaries to hold mammography claims containing HCPCS codes G0236 or 76085.
Instructions issued in the Medicare Intermediary Manual, transmittal 1864, dated October 25, 2002, CR 2332, which became effective April 1, 2003, allow the billing of CAD code 76085 in conjunction with film and digital screening mammography codes 76092 or G0202, and CAD code G0236 to be billed in conjunction with film and digital diagnostic mammography codes 76090, 76091, G0204 or G0206.
The descriptors of CAD codes 76085 and G0236 have since been changed and no longer identify screening versus diagnostic mammographies. As a result, future changes are required in the billing of these devices as follows:
The proper billing of CADs effective October 1, 2003, allows for billing of CAD code 76085 with film screening or diagnostic mammography codes 76090, 76091 or 76092 and the billing of CAD code G0236 with digital screening or diagnostic mammography codes G0202, G0204, or G0206.
Instructions are currently being developed to reflect this change in billing and will be issued at a future date.
CAD code combinations included in the Correct Coding Initiative (CCI) edits in the Outpatient Code Editor (OCE) for April 2003 have not been updated to reflect the proper code combinations as indicated in transmittal 1864. Therefore, claims containing CAD codes listed above will not process to payment. The CAD CCI edits will be removed from the July 2003 OCE so these claims can process to payment.
As a result, the held claims will not be released for payment until the July OCE is implemented. In a future release of the OCE, the CAD CCI edits will be included. This should happen in the January 2004 OCE release.
At that time, mammography claims reflecting CAD codes will be subject to these CCI edits.