Wiki Icd for Primary prevention denials

[mdm58]

Seems all of our ICD 33249 are denying that are being billed for Primary prevention. Since we changed from CAHABA to Palmetto we are getting medical necessity denials. Does anyone else have this problem and does any one know if the requirements have changed or what's the deal

 

[kimmyjwright]

Seems all of our ICD 33249 are denying that are being billed for Primary prevention. Since we changed from CAHABA to Palmetto we are getting medical necessity denials. Does anyone else have this problem and does any one know if the requirements have changed or what's the deal

My practice is also having this problem. Does anyone know how to get these paid? Also, the KZ modifier is the appropriate modifier for this code correct???

 

[pnepooh]

You need to apply modifier Q0 for ICD Insertions if it meets the guidelines set by Medicare. Modifier KZ is for Pacemaker Insertions.

 

[kimmyjwright]

You need to apply modifier Q0 for ICD Insertions if it meets the guidelines set by Medicare. Modifier KZ is for Pacemaker Insertions.

KX is for pacemaker insertion. VERY little info on KZ...

 

[nellt]

NCD 20.4 has just been updated by Medicare. It gives the medical necessity for ICD insertions for primary prevention of SCD.