Wiki TAVR denials

[deeva456]

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,

 

[JudyW]

Here is a link that might be of some help to you.

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM7897.pdf

 

[nclb85]

We have been getting a lot of denials for our TAVRs as well. We have the current trial number and IDE in the appropriate areas on our claims, but are still getting denial MA50 - Missing/Incomplete/Invalid IDE number for FDA-approved clinical trial services. This is the site I got the numbers from: http://www.cms.gov/Medicare/Coverage/Coverage-with-Evidence-Development/Transcatheter-Aortic-Valve-Replacement-TAVR-.html

Is there a more current set of numbers that we need to use???

 

[coop22]

If you are to google the device then Facility and Physician Billing Guide it helps you better (in my eyes understand what everybody is looking for) This is just one example for the TAVR from Edwards. Look into all the notes sections.

http://ht.edwards.com/scin/edwards/.../transcatheter/2014thvbillingguidear10818.pdf

 

[billysun35]

TAVR must have a 62 modifier add to the code not modifier 80. hope this helps.

 

[deeva456]

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.

 

[Misty Dawn]

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

 

[sharris8888]

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 ?

 

[coop22]

No they do not. We use I35.0 and Z95.2