Wiki Billing 93294(Remote Pacemaker Interrogation)

[ncolleton87]

In recent months, I noticed an increase number of denials from Medicare regarding remote pacemaker interrogations. They are being denied as not medically necessary or too many services billed. According to Medicare LCD edit, L30529, it states that remote pacemaker interrogation can be preformed every 90 days. Our office schedules these checks between 90 to 91 days. I have spoke with multiple representatives at Medicare and they are all stating that patient can only have 3 within a 360 day rolling period. When I ask for more explanation, I am being told to refer to L30529 policy. However, I am unable to locate that information. I have done 1st and 2nd level appeals, but they are being denied for same reason. I have researched for months and even requested to speak with supervisor at Medicare regarding the denial, but I have not gotten a response. I am running out of options. Has anyone else had same denials regarding CPT code 93294(remote interrogation check, 90 days)? Please help. Thanks!

 

[jcrews@wacocardiology.com]

Remote checks denied for 360 days

Did you ever find out what they were doing? We are now running in to this and multiple Medicare supervisors can't explain their math on 90 days not equaling the 360 days nor where this is written... Thanks

 

[bmil]

Remote Device Checks wrongly denied by Novitas

We have found that they are not educated on the definition of the code and/or apparently turned on some edit recently. We can't get them to correct it but are getting paid on appeal. Most on first level but before we figured out how to teach them some had to go to second level.

The problem is they are not fixing this so almost all of them need appeal. They aren't counting the frequency taking into consideration the 90 day subscription so they either bundle programing checks into these or they bundle them into each other even though they are 90 days apart.

They have made similar errors on other services in the past and told us that they won't fix their errors until they get large numbers of complaints. So if you are having this problem, be sure to appeal and complain or else they will just keep doing it.