I need help!

PYARNELL

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Does any else have problems when billing 33249? When this code hits the scrubber we get an edit saying
it has to be billed with modifier QO. Per Medicare QO indicates patient AICD is part of a clinical trial. This code
can be billed with certain DX but often when this code is used the Dx's aren't appropriate and pt is not part of
clinical trial. I don't want to attach the QO modifier just to get paid but we do want to get paid. Does this happen to
anyone else?
 
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jewlz0879

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Our scrubber always tags CPT Code 33249 saying it needs modifier QO.
Modifier QO indicates AICD is registered in a clinical trial or a clinical study.
Edits we have are for Medicare patients not in any trials or studies. Are there
other codes to bill the same procedure if not in trial or without allowed DX codes?
This keeps comming up and I hope someone has an answer for me. Thanks
I'm not sure I'm following your question 100% BUT we bill for PM's and ICD's all the time without QO, but with appropriate dx code such as 428.22. We don't have any problem but I have noticed recently Medicare wants to review these and is requesting records. Not sure why.
 
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