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?
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Wiki 33249-Insert/Reposition of Leads
- Thread starter kkfremane
- Start date
Misty Dawn
Guru
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.
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
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.