Wiki TAVR denials

deeva456

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Hello.

I've been receiving alot of denials from Medicare on our TAVR procedures: 33361-33366 for missing modifier Q0 and trial registry number. This is an easy fix; however, also receiving denials on these codes for the assistant surgeon. Has anyone else been getting denials for the assistant?

I appreciate any and all feedback!

Thank you,
 
Thank you for your input. We have billed all our TAVR claims with the correct information on the claim; clinical trial number, IDE, dx, POS and modifiers and again on 7/7/14 received more denials from Medicare for the dx. Making a few phone calls today and hopefully this will be resolved.
 
Is your doctor working with a doctor in another office? When one claim denies both will deny. This happened with us. So if your claim is right check with the other office and see if they are billing the samething. The claim tickets need to mirror each other.

Example:
Interventionalist:
424.1 (1st dx), V70.7(has to be 2nd) 3336X 62(1st modifer), Q0(2nd)
IDE# 01737528 (NO CT for electronic claims. Only the numbers. CT is only for paper claims.)

Then the cardio surgeons needs to match the above exactly. (they may have additional codes and that is ok as long as the claim line with the primary TAVR code match and the DX and modifiers are in the correct order.

You can only bill for the Two primary providers. Even if muliple cardiologist/surgeons. No 80 modifier because the TAVR codes automatically deny without the 62 modifier.

Misty Sebert, CPC, CCC
 
Question

Is your doctor working with a doctor in another office? When one claim denies both will deny. This happened with us. So if your claim is right check with the other office and see if they are billing the samething. The claim tickets need to mirror each other.

Example:
Interventionalist:
424.1 (1st dx), V70.7(has to be 2nd) 3336X 62(1st modifer), Q0(2nd)
IDE# 01737528 (NO CT for electronic claims. Only the numbers. CT is only for paper claims.)

Then the cardio surgeons needs to match the above exactly. (they may have additional codes and that is ok as long as the claim line with the primary TAVR code match and the DX and modifiers are in the correct order.

You can only bill for the Two primary providers. Even if muliple cardiologist/surgeons. No 80 modifier because the TAVR codes automatically deny without the 62 modifier.

Misty Sebert, CPC, CCC





Can you tell me if rounding visits and/or follow up office visits also have to have the Q0 modifier with the Z00.6 dx and Clinical trial number ?
:confused:
 
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