tci Part B Insider - 2009 Issue 40

In other news ...

• If you've been frustrated over gender-specific edits for your Medicare claims, CMS has a solution to some of those problems. You'll use new condition code 45 (Ambiguous gender category) with claims that may be denied "due to sex/diagnosis and sex/procedure edits," according to MLN Matters article MM6638, issued on Oct. 28. You'll use this code when "the service performed is gender specific (i.e., services that are considered female or male only)," the article notes. "This claim level condition code should be used by providers to identify these unique claims and to allow the sex-related edits...

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