Wiki Cpt 33249 - denials for this code


Los Angeles, CA
Best answers
we are getting denials for this code, any advise how to bill it? we tried with mod Q0 and without modifier.

Any assistance would be greatly appreciated

What is the denial for? There is an NCD edit that states Medicare will no longer pay for dual chamber PM/ICD with dx of 427.31 that they want an initial single PM first.

The Q0 is used on the initial defibrillator and is used to identify patients whose data is being submitted to a registry and to document meeting the coverage requirement for devices implanted for primary prevention of sudden cardiac arrest.
The Q0 (Q-Zero) modifier should only be applied if it is a primary prevention implant - this should be about 95% of the defibrillators you report. Patients typically have an associated diagnosis that is heart failure, old myocardial infarction, and/or non-ischemic dilated cardiomyopathy. You should not use the Q0 modifier if it is a secondary prevention implant - these patients will have a diagnosis that indicates they have had ventricular fibrillation, sustained ventricular tachycardia, or sudden cardiac death. While the national coverage policy doesn't specify this, I have found that the modifier must be used with an associated primary prevention indication - it essentially directs the claim processing system to look for one of the primary prevention indications.

Jim Collins, CPC, CCC
President, CardiologyBiller.Com