Editing Instructions for A/B MACs (A)

80.6 - Editing Instructions for A/B MACs (A) (Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21) Edit 1 - Implement diagnosis to procedure code edits to allow payment only for the LOPS codes, G0245, G0246, and G0247 when submitted with one of the following ICD-10-CM diagnosis codes If ICD-10-CM is applicable: ICD-10-CM ICD-10 DX Description E08.40 Diabetes mellitus due to underlying condition with diabetic neuropathy, unspecified E08.42 Diabetes mellitus due to underlying condition with diabetic polyneuropathy E09.40 Drug or chemical induced diabetes mellitus with neurological complications with diabetic n E09.42 Drug or chemical induced diabetes mellitus with neurological complications with diabetic p E10.40 Type 1 diabetes mellitus with diabetic neuropathy, unspecified E10.41 Type 1 diabetes mellitus with diabetic mononeuropathy E10.42 Type 1 diabetes mellitus with diabetic polyneuropathy E10.43 Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy E10.44 Type 1 diabetes mellitus with diabetic amyotrophy E10.49 Type 1 diabetes mellitus with other diabetic neurological complication E10.610 Type 1 diabetes mellitus with diabetic neuropathic arthropathy E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy E11.44 Type 2 diabetes mellitus with diabetic amyotrophy E11.49 Type 2 diabetes mellitus with other diabetic neurological complication E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified E13.41 Other specified diabetes mellitus with diabetic mononeuropathy E13.42 Other specified diabetes mellitus with diabetic polyneuropathy E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy E13.44 Other specified diabetes mellitus with diabetic amyotrophy E13.49 Other specified diabetes mellitus with other diabetic neurological complication E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy Deny these services when submitted without one of the appropriate diagnoses. Use the same messages you currently use for procedure to diagnosis code denials. Edit 2 – Deny G0247 if it is not submitted on the same claim as G0245 or G0246. Use MSN 21.21 - This service was denied because Medicare only covers this service under certain circumstances. Use RA claim adjustment reason code 107 - The related or qualifying claim/service was not identified on this claim. NOTE: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.