Wiki 93293

[deeva456]

Hello,

I think this subject came up before but I could not find the link.... Due to the age of the pacemaker generator, some are nearing "end of life" We are doing transtelephonic pacemaker evaluations every 30 days. We are receiving some denials because the analysis is performed more frequently than 90 days. If you have been denied payment on this code, did you rebill with modifiers or appeal the denial?

I appreciate any feedback on this subject.

Thank you!
Dolores, CPC - CCC

 

[asnelling]

Hello ~ We only bill these every 90 days.I don't think they should be appealed because the CPT book states up to 90 days. I do have a question for you though; do your physicians have their own report for these services, or do they use the telephonic report. The CPT book states includes physician report. Just curious. I don't think my physician is giving me what I need.

Thanks for your advice.

 

[sbicknell]

You didn't say how long ago the PM unit was placed or how often you are doing the PM checks but here is a paste of the frequency guidelines from CMS.

All routine PM checks are coded V45.01 until end-of-life is validated and then code that PM check V53.31


The frequency guidelines for TELEPHONIC PM checks are:

Single-Chamber Pacemaker
1st month – every two weeks
2nd through 36th month – every eight weeks
37th month to failure – every four weeks

Dual-Chamber Pacemaker
1st month – every two weeks
2nd through 6th month – every four weeks
7th through 36th month – every eight weeks
37th month to failure – every four weeks


The frequency guidelines for IN-PERSON PM checks are:

•Single-chamber pacemakers – twice in the first six months following implant, then once every 12 months.
•Dual-chamber pacemakers – twice in the first six months, then once every six months.

 

[deeva456]

Hello ~ We only bill these every 90 days.I don't think they should be appealed because the CPT book states up to 90 days. I do have a question for you though; do your physicians have their own report for these services, or do they use the telephonic report. The CPT book states includes physician report. Just curious. I don't think my physician is giving me what I need.

Thanks for your advice.


Hi AS...

Our physicians do not do a dictated report, they only use the telephonic report. We will give a copy of the telephonic report to Medicare or other payer if one is requested. We have never had problems with a payer not accepting the report.

Thanks for your response. The guidelines for the this code does not make sense... we can check the generator life monthly if necessary but not via telephonic methods because it is payable every 90 days.

Thanks again,