Wiki Denial on CPT 33249 by Texas Medicare

[bcousey26]

I've been on the phone with Notivas (Medicare-JH4-MAC) regarding the denial of CPT 33249. According to the rep, the claim was denied as it needs either a Q0 or Q1 modifier, in addition to an medically necessary diagnosis code.

The medical necessity of the diagnosis code is more than understandable, but I've never and I mean NEVER had to use either a Q0 and/or Q1 on 33249. Is this a new rule? From what information I can gather these modifier are used for clinical research patient-This patient is not under clinical research to my immediate knowledge.

Is anyone else having to place Q0/Q1 modifier when billing 33249. Where can I locate educational information under CMS or Notivas so that I can inform our charge entry staff.

This is confusing....Any help is greatly appreciated.

 

[L4uniki]

CMS Requirements

Your best solution is going to be to call CMS and ask them to acquaint you with any adjustments in their requirements for this code. Their requirements have a tendency to change often; they do notify us, but, as you well know, we are all busy and sometimes miss requirement notifications unless we work directly with nothing but CMS coding.

I have found it most beneficial to create liaisons within the payer offices so that anytime I have a problem with denials, rejections, or unfamiliar coding I just call and ask what they require.

L4uniki

 

[bcousey26]

Thank you for your assistance, but I have contacted Medicare. I just wanted to confirm if this was something that any other MAC has experienced. I've searched all of my bulletins that I receive from Medicare and haven't had any luck.

Each employee at our practice, regardless of their position and/or title, receives bulletins from CMS to ensure that we're up to date with any possible denials, updates, etc.

What that being said-is there anyone else that has experiences this type of denial because this one is very odd.....We've never had to place this type of modifier onto a ICD.

 

[lndavis]

33249 denials

Thank you for your assistance, but I have contacted Medicare. I just wanted to confirm if this was something that any other MAC has experienced. I've searched all of my bulletins that I receive from Medicare and haven't had any luck.

Each employee at our practice, regardless of their position and/or title, receives bulletins from CMS to ensure that we're up to date with any possible denials, updates, etc.

What that being said-is there anyone else that has experiences this type of denial because this one is very odd.....We've never had to place this type of modifier onto a ICD.

I'm in Arkansas and Novitas is our MAC and we are receiving denials wanting the Q0 modiifer as well. Did you receive any information or get this resolved. The patients that I have are not in clinical trials.