That is basically the indication for primary prevention. The concept is to prevent sudden cardiac death in patients with CAD, ischemic cardiomyopathy with a low ejectin fraction...
here is some more explanation from a very good article on wake forest/baptist health website....
"CMS has determined that patients with coronary artery disease and an ejection fraction of less than or equal to 35% are now indicated for an ICD. This decision increases the lower limit of the qualifying ejection fraction from 30 to 35% and eliminates the need for secondary indicators of risks..
CMS has also approved a new diagnosis for primary prevention which includes nonischemic dilated cardiomyopathy with New York Heart Association Class II and III. Therefore, patients with idiopathic dilated cardiomyopathy and other forms of cardiomyopathy with ejection fraction of 35% or less are now indicated for an ICD. The only caveat is that this diagnosis must be in place for at least nine months. If the diagnosis has been in place from three to nine months, the patients can have an ICD but they will need to be entered into a special registry, either an independent registry from each institution approved by the Institutional Review Board (IRB) or a yet to be established ACC/Heart Rhythm Society Registry.
In addition, New York Heart Association Class IV patients are now indicated for an ICD if they meet the requirements for cardiac resynchronization therapy.
Essentially all patients with some type of organic heart disease and ejection fraction of 35% are now qualified for an ICD. These patients should be considered for referral to an institution capable of implanting these devices. These institutions should have a low complication rate and high rate of successful ICD implantation and provide a patient registry as required by CMS. This decision by CMS has removed many of the ethical and financial concerns regarding indications for ICD implantation making it easier for physicians to provide the medical care that is proven to be necessary."
it sounds like this is a Q0 modifier situation...call the hospital's cath lab and ask if they have a nurse in charge of the Primary prevention's Registry. she will be able to tell you if that patient is on the registry if so, then you need to append the Q0 modifier (if medicare) and rebill...
hope this helps
Louise CPC