Wiki EP Ablation after Pacemaker Implant

[LindseyModica]

Good Morning! I have a patient who had a dual Pacemaker implant on 9/3/2019.
On 11/5/2019 patient had PVI ablation that I am having a hard time getting paid with Medicare. Here's what was billed.

9/3/2019 33208, KX Dx: I49.5 I48.1

11/5/2019 93656,78 93655,78 93613 93623,26,XU 93662,26,XU
DX: I48.19 and I48.3 for 93655

Medicare is saying the procedure is inconsistent with modifer, claim is unprocessable. What am I doing wrong? I've never had a problem with these until recently and (of course) Medicare will not tell me anything useful. Thank you so much for any input!

 

[twizzle]

My thoughts are that the modifier should be either 79 or 58 depending on the documentation. The pacemaker was not placed for a fib it was placed for SSS. As such, the PVI ablation is unrelated to the pacemaker procedure and should therefore have modifier 79 not 78.

If the documentation supports the PVI was planned which documentation such as "patient presents today for a fib ablation now that their SSS is stable following pacemaker insertion" supports then modifier 58 is appropriate; this indicates the PVI was planned. I do think that the time-frame between the two procedures favors modifier 79 though. A planned ablation would more than likely have occurred sooner than 2 months following the pacer.

 

[LindseyModica]

My thoughts are that the modifier should be either 79 or 58 depending on the documentation. The pacemaker was not placed for a fib it was placed for SSS. As such, the PVI ablation is unrelated to the pacemaker procedure and should therefore have modifier 79 not 78.

If the documentation supports the PVI was planned which documentation such as "patient presents today for a fib ablation now that their SSS is stable following pacemaker insertion" supports then modifier 58 is appropriate; this indicates the PVI was planned. I do think that the time-frame between the two procedures favors modifier 79 though. A planned ablation would more than likely have occurred sooner than 2 months following the pacer.

That makes sense. Thank you so much for your help! I'm going to try your suggestion.