Wiki 33249 proc to dev edit - pacer lead

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jengel

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Has anyone had a denied claim for a procedure to device edit because a pacer lead C1898 was implanted as an atrial lead for the ICD? C1898 is not included as a lead that will satisfy the edit as it is considered a pacer lead. Medtronic reimbursement was well aware of this issue but could not advise other than contacting the contractor. Has Medicare made any statement re this issue that anyone knows of?
 
We've been having the same problem, it's an absolutely RIDICULOUS edit. Of course you need a pacemaker lead for the RA lead in an ICD. There's been a lot of different issues with different device edits ever since the CPT codes for ICDs changed this year, but this one just strikes me as the dumbest one by far. We're working with Palmetto to resolve it but for now my understanding is that it hasn't been fixed yet. Hopefully will be fixed in the next version.
 
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thanks Rich - of course you only run into this issue when the RA lead is the ONLY lead implanted with the ICD or one of the other leads would satisfy the edit - thanks for your input
 
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