Wiki ICD coding for an ASC

[juneh]

Please Help! I have submitted my claim for a 33249 with diag code 428.42. This was denied with reference to this National Coverage Determination Publication 100-3 Manual Section 20.4. We are the facility. We are new to cardio billing and coding. Any assistance out there? Is anyone else billing for ASC's for cardio?

 

[twizzle]

ICD coding

Please Help! I have submitted my claim for a 33249 with diag code 428.42. This was denied with reference to this National Coverage Determination Publication 100-3 Manual Section 20.4. We are the facility. We are new to cardio billing and coding. Any assistance out there? Is anyone else billing for ASC's for cardio?

If this is a Medicare patient it may be denied because it requires a Q0 modifier to show the device was inserted for primary prevention of sudden cardiac death in the absence of any arrhythmias. Do you have any other Dx's?

 

[juneh]

It is a medicare patient. So if there is an arrhythmia, I can forgo the Q0 modifier? Where might I find this information written? Thank you! Might need ya again!

 

[twizzle]

ICD in an ASC

It is a medicare patient. So if there is an arrhythmia, I can forgo the Q0 modifier? Where might I find this information written? Thank you! Might need ya again!

You can Google Q0 modifier but basically it's a CMS coverage policy. The arrhythmias are 427.1, 427.41, 427.42, 427.5, 427.9. If any of these appear on the claim then you do NOT use Q0 as it will deny. These arrhythmias can be either induced or spontaneous and ICD placement is considered to be for secondary prevention of sudden cardiac death. The primary prevention codes include cardiomyopathies, ischemia, MI's, congestive/ heart failures and so on.
As I say, this is only for Medicare patients, not Medicare replacements or Commercial.

 

[juneh]

Way cool! Thanks and wish me luck. I love to learn a new specialty, I just wish CMS was more forthcoming with their guideline.