Wiki 33249 and 33225

[Kcronin1122]

I am billing cpt codes 33249 and 33225, it was denied for appropriate modifier needed. This is a VA insurance.
Anyone know what modifier needs to be used?

 

[twizzle]

I am billing cpt codes 33249 and 33225, it was denied for appropriate modifier needed. This is a VA insurance.
Anyone know what modifier needs to be used?

Perhaps you could supply some more information by sharing the operative report.

 

[thomas7331]

I'm not familiar with the VA-specific requirements, but if they're following CMS rules, they may be looking for a KX modifier as an attestation that the coverage requirements have been met for this device.

 

[espressoguy]

I'm not familiar with the VA-specific requirements, but if they're following CMS rules, they may be looking for a KX modifier as an attestation that the coverage requirements have been met for this device.

I've never used the KX modifier for ICDs, only pacers. More likely, if the VA follows CMS rules they would be looking for a Q0 modifier. However, this modifier is dx dependent and without the op report it is only a guess.

 

[kimmyjwright]

The KX is not appropriate. If following Medicare guidelines...it would be KZ...not Q0? I was under the impression Q0 was not longer used, but a KZ was...can someone clarify? Also, since Palmetto became effective...they want different dx. If someone is actually getting paid for these..PLEASE RESPOND..