BILLING NEWS

WPS Medicare Corrects L33219 (IHC Denials)

WPS Medicare revised LCD L33219 Molecular Diagnostic Testing effective Aug. 1, 2014. The revised LCD, which focuses on the clinical indications for various molecular diagnostic tests, mistakenly captured immunohistochemistry (IHC) codes G0461 and G0462 as well. Only three ICD codes (V16.0, V84.04 and V84.09) associated with history or susceptibility for Lynch syndrome-associated cancer support the medical necessity of IHC according to L33219. As a result, pathologists and laboratories in J5 and J8 have been denied coverage for all IHC services with dates of service on and after Aug. 1. The PathConsulting team filed a request Sept. 8 with WPS Medicare to correct the LCD. WPS Medicare agreed that L33219 far too narrowly limits the diagnosis codes that support the medical necessity of IHC. Therefore, it plans to issue a revision to L33219 “that will be posted to its website October 1, 2014.” The revised policy will “remove the current diagnostic restrictions listed in L33219 for G0461 and G0462.” Furthermore, WPS “will be performing a mass adjustment on claims that have been inappropriately denied” since Aug. 1, with the mass adjustment taking place roughly the end of September.


INDUSTRY NEWS TAGS: WPS Medicare, MAC J5, MAC J8


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