Wiki Device check and Office visit same day

[dls]

Some of our patients come in for their 6month office visit and have their pacemaker or ICD checked on the same day. It is 2 different appts, that have obviously their own claim. I put a modifier 25 on the E/M. Both visits have always been paid, but now with ICD-10 I got a rejection on the office visit stateing DX codes Z95.0 (presence of pacemaker) and Z45.018 (encounter for adjustment) is not passing iCES edits and was rejected. This was billed to Medicare plus Blue advantage. Has anyone else experienced this and if so how do i fix it? My solution was to send back the E/M claim without Z95.0.

 

[Annmarie4412]

When patients come into my facility for cases like this one: Two different appointments, two different ticket numbers... I do put the 25 modifier on the E/M, however the thing I do differently for the pacemaker, is I add the reason the patient has it as the primary diagnosis and the additional Zcode secondary, and these claims seem to be getting paid as I have not had any regection for them. Also, for the E/M, I leave any diagnosis the provider adds, but I do make sure there is a payable primary diagnosis. For example, if the provider drops a Zcode as the primary and Atrial Fib secondary, I put the A Fib primary.

I hope this answers your question!

 

[SDAlward]

I use Z45.010 and Z45.018 for my dx codes for pacer checks. Z45.02 for defibs. I put the E/M visit on another ticket with mod 25