This table displays Part A and Part B processing issues that are being worked currently or have been resolved recently.
Computed tomographic angiography of the chest, heart, and coronary arteries -- claims may have been denied in error
Claims submitted for computed tomographic angiography of the chest, heart, and coronary arteries (procedure codes 75571-75574) between October 1, 2015, and September 5, 2016, may have been denied in error when billed with diagnosis codes I35.0, I35.1, I35.2, I35.8, I48.0, I48.1, I48.2, and I48.91.
Ambulatory surgical centers (ASCs) that received an incorrect payment for Healthcare Common Procedure Coding System (HCPCS) C1822 and/or Current Procedural Terminology (CPT®) 63685 when performed with HCPCS C1822 received adjustments to previously processed claims.
First Coast has become aware of processing issues for pneumococcal and influenza vaccinations where in some instances the vaccination is not being priced, and in other instances, the vaccination is being priced; however, coinsurance is being applied in error.
Healthcare Common Procedural Coding System (HCPCS) code J7328 was overpaid in error for dates of service on or after January 1, 2016.
Major joint replacement (hip and knee) -- claims may have been returned to the provider (RTP) in error
Claims submitted related to local coverage determination (LCD L33618) - major joint replacement (hip and knee) between October 1, 2015 and January 28, 2016, may have been returned to the provider (RTP) in error when billed with ICD-10-CM procedure codes 0SP90JZ, 0SPB0JZ 0SPC0JZ, and 0SPD0JZ.
Procedure codes 0V507ZZ and 0V508ZZ were listed in the FISS narrative in reason codes 34912, 59055, and 59056 in error. This issue has been corrected and the reason codes have been reactivated per change request 9631.
Part A services that deny in error as a result of ICD-10 diagnosis changes resulting from change request 9806 will be adjusted when brought to our attention after December 5. [CR 9806]
Medicare Part B services that deny in error as a result of ICD-10 diagnosis changes resulting from change request 9806 will be automatically adjusted after December 5 implementation. [CR 9806]
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to specimen validity testing (SVT). Providers who received payment in error will receive a demand letter requesting the monies back.
Application of skin substitute grafts for treatment of DFU and VLU of lower extremities -- overpayments
First Coast Service Options Inc. has identified an internal processing issue that resulted in overpayments related to the application of skin substitute grafts for treatment of diabetic foot ulcers (DFU) and venous leg ulcers (VLU) of lower extremities. Providers who received payment in error will receive a demand letter requesting the monies back.
Some hospital and long-term care hospital (LTCH) claims with discharge dates on or after October 1, 2016, may be grouped to an incorrect Medicare severity -- diagnosis related group (MS-DRG). A revision has been made and affected claims will be reprocess by February 1.
Claims submitted for computerized corneal topography (procedure code 92025) between October 1, 2015, and August 7, 2016, may have been denied in error when billed with diagnosis codes H11.811-H11-819, H18.51, H18.52, H18.53, H18.54, and H18.55.
First Coast Service Options Inc. (First Coast) suspended all claims with reason code W7099 due to system errors. First Coast will release the affected claims in January 2017 with the update of the outpatient code editor (I/OCE).
A national issue has been discovered involving claims denying incorrectly for ICD-10.
There are no items in this section at this time.
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