Wiki Lynn Pickett CPC

[lpick]

Pacemaker check question. When billing a PM check, we use the diagnosis for the reason the PM was put in such as SSS. We are told by Humana that this is incorrect and we should only use Z45.010. Any help?

 

[Casper204]

We always use Z95.0 or Z95.0 and Z45.010 when it's a routine check up. I haven't had any denials based on diagnosis codes when using them.

 

[lpick]

So you don't use SSS at all?

 

[Casper204]

No, not for routine checks. Except with Wellcare because they don't like Z codes as the primary diagnosis. Then I'd put the reason for the pacemaker but for all other carriers we use the Z codes. If the physician documents anything abnormal during the check then I'll add those codes as well. It's routine required follow up and the reason you're doing it is because they have a pacemaker so that should be the only dx you need. We haven't had any problems billing that way. Hope this helps.