Highmark is experiencing an increased volume of incorrectly coded claims for preventive lung cancer screening, leading to denials and delayed payments.
Annual lung cancer screening (71271) and counseling (G0296) are covered under Highmark’s Preventive Schedule, but they must be accompanied by the appropriate primary diagnosis code to process correctly as preventive:
Z87.891 (Personal history of nicotine dependence) or
Z122 (Encounter for screening for malignant neoplasm of respiratory organs)
Currently, many providers are incorrectly submitting primary diagnosis code F17210 (Nicotine dependence, cigarettes, uncomplicated) for the annual lung cancer screening. This code will be rejected or denied for the preventive lung cancer screening.
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