Wiki CPT code 33274 claim denial requiring anatomical modifier?

[she803]

Hello everyone--I need assistance regarding claim denial for CPT code 33274?

Maybe I'm missing something, but I do not understand the reason anatomic modifier is required for a pacemaker procedure?

We've never received denial requiring anatomic modifier for this specific procedure before until now--please assist.

Thanks in advance!

 

[nickelclaw]

here is a MCR NCD link not sure if this will help. If this code or a few others is coded with the group 1 or 2 dx then apply the modifier KX to 33274 stating that requirements in policy have been meet if not there are some other mods as well. This is the only time I have put mods for this code not anatomic mod.

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54831&ver=26&keyword=&keywordType=starts&areaId=all&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=33274&hcpcsEndCode=33274&sortBy=title&bc=1

 

[nickelclaw]

sorry it is an LCD so you will have to search if your state has the same

 

[vidraj]

Hi,

We append KX modifier for the leadless PM.

Since you have mentioned it as Anatomical Modifier denial,

1. Considering the description for the CPT 33274 -
" Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed",
maybe they are looking for modifier RT?

AAPC Forum reference for the CPT 333274: https://www.aapc.com/discuss/threads/micra-leadless-pacemaker-cpt-33274.171490/

or

2. Modifier reference link: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00003604
Check under Anatomical modifiers , there is a note:
If the anatomical modifiers can’t be described by using one of the above modifiers, reference Proper Use of Modifiers 59 &- X{EPSU}.

I would check
- if KX modifier is appended
- CCI Edit to see if modifier 59 is needed
If both are correct the final one is to call and see if RT needs to be added as per payer policy.

Hope this helps.