tammymills97
Networker
I am relatively new to coding implanted cardiac device interrogations and we are receiving a denial from Medicare for 93295 and 93296 billed with POS 11. The denial reasons we received states Px/Bill type inconsistent with POS and Incomplete/Invalid place of service. The patient was admitted to a general medical floor from 5/13/25-5/18/25 and then on 5/18/25 was transferred to the inpatient rehab unit of the hospital until the end of the month. The patient's remote monitoring period for his ICD began on 2/26/25 and ended 5/27/25 so the 93295 and 93296 were billed out with 5/27/25 since that was the end of his 90 period.
We also have a patient that has a CardioMEMs and at the end of her 30 day remote monitoring period she was an inpatient in the hospital. 93264 was billed with POS 11 and Humana Medicare initially paid for this but then did a recoup and our A/R staff said in the notes "DOS billed in POS 11 cannot overlap with IP claim per CMS". The patient was only inpatient for 4 days but again the end of the remote monitoring period was right in the middle of her inpatient hospital admission.
With these patients only being admitted at the end of the 30 or 90 day period can the codes be reported with POS 21 or do we just have to take the denial? Is there guidance from CMS that I can reference and show to the physicians if we have to take the denial?
Any help is greatly appreciated!
We also have a patient that has a CardioMEMs and at the end of her 30 day remote monitoring period she was an inpatient in the hospital. 93264 was billed with POS 11 and Humana Medicare initially paid for this but then did a recoup and our A/R staff said in the notes "DOS billed in POS 11 cannot overlap with IP claim per CMS". The patient was only inpatient for 4 days but again the end of the remote monitoring period was right in the middle of her inpatient hospital admission.
With these patients only being admitted at the end of the 30 or 90 day period can the codes be reported with POS 21 or do we just have to take the denial? Is there guidance from CMS that I can reference and show to the physicians if we have to take the denial?
Any help is greatly appreciated!