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Thread: 33249-Insert/Reposition of Leads

  1. #1
    Join Date
    Apr 2007
    Posts
    11

    Default 33249-Insert/Reposition of Leads

    Promo: Code Books
    Keep receiving denials from CMS that Dx's do not meet Medical Necessity. I was told the only Dx's that meet Medical Necessity are 427.1,427.41,427.42,427.5, and 427.9. Has anyone else had trouble getting Medicare to pay this code with any other dx?

  2. #2
    Join Date
    Apr 2007
    Location
    Spokane, WA
    Posts
    140

    Default

    For Medicare: If you primary dx is any of the following codes do not need to append the QO modifier:
    427.1,427.41,427.42,427.5,427.9,v12.53,996.04.
    If your primary dx is not one of the above; such as: 428.22, 412 or 425.4 you will need to append Q0 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.
    Do not use Q0 if it is a commercial carrier.

  3. #3
    Join Date
    Apr 2007
    Location
    Orange Park Florida
    Posts
    40

    Default

    i agree, if your diagnosis is not what he listed in above reply then you have to attach the Q0 modifier in order for them to pay. hope it helps.
    Amanda Solomon CPC
    New Member Devlepment Officer of Orange Park Chapter

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