AHA Coding Clinic® for HCPCS - 2003 Quarter 2
Mammography claims on hold until July 2003
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...
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Article Overview
This article explains a CMS update affecting mammography claims and the timing of payment holds tied to computer-aided detection billing. It is relevant to billing staff, coders, and compliance teams working with Medicare outpatient claims, especially those following HCPCS code updates, intermediary instructions, and Correct Coding Initiative edits.
Why This Topic Matters
The article helps readers understand that claim processing may be affected by CMS transmittals, outpatient edit schedules, and later code-billing changes for mammography services. It is useful for tracking when claims may be delayed and how Medicare system updates can affect reimbursement workflows.
What You Will Learn
- How CMS instructions affected the handling of mammography claims.
- Which Medicare editing and claims-processing updates were discussed.
- How future system releases were expected to change claim processing for these services.
- The general scope of the billing updates and timing references in the article.
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Compliance professionals
- Radiology practices
- Medicare claims administrators
Codes Discussed
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