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Help with denial on 33249

  1. #1
    Default Help with denial on 33249
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    Please need your help----- we are receiving denials on 33249 for the dx codes--
    i know there are list of acceptable codes-- but cannot find them- can anyone send a list or link for me--in South Carolina Palmetto GBA
    thank you in advance

  2. #2
    How about 414.8,425.4 428.0 428.1 427.1 v53.32 996.04. I got this from codecorrect.

  3. #3
    The three Dx that fit the criteria for 33249 are the prim. dx of CHF , then a type of block, third is an arrthrymia. This is how we have been coding 33249 have had some denials but once we submit records it usually is paid. Hope this was a help to you.

  4. #4
    If you primary dx is any of the following codes do not need to append the QO modifier:
    If your primary dx is not one of the above; such as: 428.22, 412 or 425.4 you will need to append QO modifier.
    "Just make sure to attach the Q0 (Q-Zero) modifier to all primary prevention implants along with a diagnosis code that is in line with the appropriate primary prevention indication(s), such as: 428.22 (Chronic systolic heart failure), 412 (Old myocardial infarction), or 425.4 (Other primary cardiomyopathies)."
    I got this information from the EP digest article by Jim Collins, Zhealth and NCD. We do not recieve denials on our 33249.

  5. #5
    Sarasota FL
    Default 33249
    Don't forget that the Q0 modifier only applies to Medicare, not commercial carriers.

  6. #6
    The reason you are getting denials is because of Medicare's National Coverage Determinations. NCD's are like LCD's except they are National and apply to everyone. You can find these on the website. These can be tricky to look up because it is not by CPT code, but by description (i.e. Implantable Cardioverter Deifbrillator). NCD's give diagnoses and guidelines that must be met for these services. I think an example is NICM with an EF > or = to 35% and a documented history of >9 months. Hope this helps!

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