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Noridian implements temporary ICD-10 code fix for mammography and breast biopsy policies



February 07, 2018
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Women's Health 

California’s Medicare contractor, Noridian, recently implemented a temporary correction to the National Coverage Determination policies for mammograms (NCD 220.4) and percutaneous image-guided breast biopsies (NCD 220.13), allowing for the acceptance of new 2018 ICD-10 diagnosis codes. 


For both NCD 220.4 and NCD 220.13, the new ICD-10 diagnoses codes of N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41 and N63.42 were not being accepted from October 1, 2017, to January 2, 2018. These new ICD-10 diagnosis codes replaced the former diagnosis, N63, which was an unspecified code and end-dated on September 30, 2017.


The temporary correction to accept the new ICD-10 codes for these two policies became effective January 2, 2018; a permanent correction will be implemented April 2, 2018. For claims that processed incorrectly from October 1, 2017, to January 2, 2018, a mass adjustment will be completed by Noridian after the permanent implementation on April 2, 2018. No provider action is required.


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