Wiki Help with device coding

[HEATHERLEESON]

I am having trouble getting paid for the 33249 from Medicare stating not Medically Necessary. I have sent documentation and have read all the NCD's. Can anyone help?

Thanks in advance,

Heather

 

[Cyndi113]

What is the diagnosis code you are billing with the 33249?

 

[HEATHERLEESON]

The dx that I am having the most trouble with is 425.9 and anything to do with CHF

Thanks

 

[krisfelty]

You need to append the Q0 modifier if you are not billing with any of the dx codes that apply. See the Medicare B News Issue 262 June 2, 2010 on Noridian website.

Kris Felty, CPC, CCC

 

[HEATHERLEESON]

Thanks for the resource. I am billing with the modifier. The only other thing that I can think to do is write a letter.

Thanks again,

H. Hall, CPC

 

[maryawinfield04]

usually you would need to have a primary dx code when your billing for a device. (428.0-428.9) I don't know which jurisdiction you're from but Highmark Medicare policy for this is 20.4 and 20.8

 

[gski]

For Michigan, 425.9 is a non-covered diagnosis, but primary codes 425.4, 794.31, 410.12, 410.22, 410.32, 410.42, 410.52, 410.62, 410.72, 410.82, 412, 414.8, 428.0, 428.1, 428.22, 428.32, 428.42, 428.9, and secondary code 996.04 are covered. The Q0 modifier also needs to be applied for the intial insert for a 33249 to enroll the pt into their data collection system.