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Thread: Medical Necessity for CPT 33249 - We have received a few denials

  1. #1

    Default Medical Necessity for CPT 33249 - We have received a few denials

    Promo: Code Books
    Hi
    We have received a few denials from Medicare of Florida for Procedure 33249 , I have tried to look in CMS to get the Rules and ICD-9 odes that we can use to support the Medical Necessity in several occasions without any success.
    Does anybody here has the guide lines or any LCD from CMS with this information.
    Please advice.
    thanks.
    Camilo Herrera CPC

  2. #2
    Join Date
    Apr 2007
    Location
    Jackson, TN
    Posts
    62

    Default Getting paid for AICD's (33249)

    Are you billing the code with the Q0 or Q1 modifier? I refered to NCD 20.4 and several MLN Matters Articles:

    MM4273 Transmittal# R819CP
    MM5805 Transmittal# R1418CP
    MM3604 Transmittal# R497CP
    MLN Matters Number SE0517

    All of this if very useful information and we have been getting paid. I have all of this information scanned and can gladly email anyone who needs it to save you time. Just give me your email address or send me a personal message. Hope this information helps and let me know if you have any questions.
    C. Weaver, CPC, CCC

  3. #3

    Default

    no, and I think that is one of the reason we are not getting paid, but I want to be sure that we can use it for Medicare of Florida.
    I sent you an email with my Email address and I will really apreciate if you can send me thise documents.
    thanks.
    Camilo Herrera CPC

  4. #4
    Join Date
    Apr 2007
    Location
    Jackson, TN
    Posts
    62

    Default cherrra26

    I just emailed you the documents. Please let me know if you did not recieve them. Hope they help!
    C. Weaver, CPC, CCC

  5. #5

    Default

    I would really appreciate any help on the 33249, Florida Medicare Part B keeps denying. Recently, claims were sent with the QO modifier and medicare denied those claims for the QO modifier.
    Last edited by Bphelps; 09-27-2009 at 09:00 AM.

  6. #6
    Join Date
    Apr 2007
    Location
    Wichita
    Posts
    9

    Wink Q0 Modifier with LCD to go with it

    It not QO that you use its Q0 = Q, (0) :zero not Q, O. it also needs a Diagnosis that Medicare approves.

  7. #7

    Default

    Quote Originally Posted by cweavercpc View Post
    Are you billing the code with the Q0 or Q1 modifier? I refered to NCD 20.4 and several MLN Matters Articles:

    MM4273 Transmittal# R819CP
    MM5805 Transmittal# R1418CP
    MM3604 Transmittal# R497CP
    MLN Matters Number SE0517

    All of this if very useful information and we have been getting paid. I have all of this information scanned and can gladly email anyone who needs it to save you time. Just give me your email address or send me a personal message. Hope this information helps and let me know if you have any questions.
    Hi C. Weaver,
    We would truely appreciate any information you have on the AICD and medical neccessity DX...we have just started to get a couple of denials and any information you have would be great...my e-mail is rwalker@ccvmg.com...thanks for your help...

  8. #8

    Default Denials for CPT 33249

    Can CPT 33249 only be billed with the Q0 and Q1 modifiers? We perform this procedure, but not for clinical research, therefore those mods seem inappropriate. However, we are receiving many denials from Medicare of Louisiana. Can you please advise? Thanks.

  9. #9
    Join Date
    Apr 2007
    Location
    Jackson, Tn
    Posts
    7

    Default

    I would love the info emailed to sue.olson@wth.org

  10. #10
    Join Date
    Apr 2007
    Location
    Sarasota FL
    Posts
    833

    Default 33249q0

    To use the Q0 modifier the patient must be Medicare with the dx codes for congestive heart failure and/or cardiomyopathy (non ischemic) 425.4. Also if they have v tach and/or a history of sudden cardiac death V12.53 you would NOT use Q0.
    By using Q0 they are showing that the patient has the potential for sudden cardiac death hence the 33249 is being done for primary prevention. Use the Q0 for 33240 for the same reasons when the patients' ICD is at elective replacement time.
    Hope this helps.
    Last edited by twizzle; 10-08-2011 at 04:45 PM. Reason: Heading should be 33249Q0

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