Wiki Need help -Watchman Procedure non-covered services because this is not deemed a medical necessity by the payer

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vidraj

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Hi everyone,

I am looking for the updated diagnosis list to support watchman procedure to resolve a claim denial.

Below is the link which I had referred for a claim and still got denied by Medicare (33340 - Q0 - I48.20, I50.20, Z79.01, Z00.6 ,Patient's age falls between 65- 70 yrs.


Appreciate any help in understanding what I am missing out here!

Thank you
 
Doesn't that document say that claims with I48.20 will be denied? You need a more specific afib dx code, I believe.

What did Boston Scientific say when you asked them for help?
 
Hi Sharon,

Thank you for pointing that out !

Missed this tiny message below the table :

"*The unspecified code is NOT COVERED under the NCD for LAAC. LAAC claims reported with this diagnosis code will be denied".

Page 14 - of the link above also says , " *The unspecified code is NOT COVERED under the CMS NCD for LAAC.
Some private payers have included this ICD-10 code in their coverage policy".

I think I got the answer.

Thank you again.
Vidhya

(Also - Boston scientific also has the same link:
 
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