33249-Insert/Reposition of Leads

kkfremane

Contributor
Messages
11
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0
Keep receiving denials from CMS that Dx's do not meet Medical Necessity. I was told the only Dx's that meet Medical Necessity are 427.1,427.41,427.42,427.5, and 427.9. Has anyone else had trouble getting Medicare to pay this code with any other dx?
 

Misty Dawn

Guru
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166
Location
Spokane, WA
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For Medicare: If you primary dx is any of the following codes do not need to append the QO modifier:
427.1,427.41,427.42,427.5,427.9,v12.53,996.04.
If your primary dx is not one of the above; such as: 428.22, 412 or 425.4 you will need to append Q0 modifier.
"Just make sure to attach the Q0 (Q-Zero) modifier to all primary prevention implants along with a diagnosis code that is in line with the appropriate primary prevention indication(s), such as: 428.22 (Chronic systolic heart failure), 412 (Old myocardial infarction), or 425.4 (Other primary cardiomyopathies)."
I got this information from the EP digest article by Jim Collins, Zhealth and NCD. We do not recieve denials on our 33249.
Do not use Q0 if it is a commercial carrier.
 

manda12

Networker
Messages
41
Location
Orange Park Florida
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i agree, if your diagnosis is not what he listed in above reply then you have to attach the Q0 modifier in order for them to pay. hope it helps.
 
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