CMS – Palmetto Determines Local Coverages for Gastro Intestinal Panel Testing effective Dec 10th, 2018. How to code it properly moving forward.
Within the Local Coverage Determination (LCD), you will notice that only patients with immune deficiencies or those who possess certain types of conditions and/or diseases will qualify for the higher level of reimbursement with Medicare. Other diagnoses will fall under lower levels of reimbursement for our main GI Panel.
Based on patients’ conditions, they may fall into other codes and “Group” categories, which will also affect which ICD-10 codes are relevant for the “ASCENDA GIP-Parasites Bacteria Virus (22) (Stool only) Test”.
Medical records must match the patient’s diagnosis, in order for the claim to be processed. If our billing code doesn’t match the diagnostic code, then Medicare might reject the claim. If the claim is rejected, we will have to pursue the patient for payment.
Our staff will be working closely with you, to help you understand the new LCD and how to qualify patients for testing. We have created a helpful 2-page reference of ICD10 Codes for the testing.
Please see the link at ascendabio.com/icd10/palmetto-gilcd-2019.pdf for the Local Coverage Determination (LCD): MolDX: Foodborne Gastrointestinal Panels Identified by Multiplex Nucleic Acid Amplification (NAATs) (L37709) for clarification on which ICD-10 codes are appropriate for your patients’ conditions. We have attached a summary for your future testing use.
If you have any questions, please feel free to contact your local sales representative for Ascenda BioSciences or our friendly Customer Service department.
Ascenda BioSciences Customer Service 678-580-0613 Option 2