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Denials from advantage plans on defibrillator code 33249

Posted on April 20, 2018 by CPC Exam Medical Coding Updates

Hi there Coders

I am needing your help figuring out why Advantage plans are denying 33249 saying not a covered Dx (Cardiomyopathy), but is covered through Medicare and is on the NCD.
If anyone knows the answer it would be greatly appreciated.
Thank you
Rhonda S.,CPC

Medical Billing and Coding Forum

33249 with q0 modifier denial

Posted on March 15, 2018 by CPC Exam Medical Coding Updates

wanted to know how to find out if our hospital is enrolled under clinical trial for 33249? I been appending q0 modifier to 33249 but now I been getting cci edits denials saying to add either secondary prevention of cardiac arrest dx or add q0 modifier
any thoughts how to resolve the issue? in the past I never had denials with q0 modifier appended
thanks in advance

Medical Billing and Coding Forum

ICD Implant (33249) and Q0 Modifier use

Posted on December 29, 2017 by CPC Exam Medical Coding Updates

I am trying to learn and understand the use of the Q0 modifier with ICD implant when billed to Medicare. From what I understand so far, the use of this modifier is to indicate to Medicare that the patient has the potential for sudden cardiac death. So that when certain Dx are used we need to append the Q0 (ie for a Dx of Sick Sinus Syndrome I49.5). If the patient has a history of SCD and V-tach we DO NOT need to use the Q0 modifier.

Adding the modifier submits their device to a registry and documents meeting the coverage requirement for devices implanted for primary prevention of sudden cardiac arrest.

Am I on the right track here?

Thanks for any information/insight.

Medical Billing and Coding Forum

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Tag Archives: 33249

Denials from advantage plans on defibrillator code 33249

33249 with q0 modifier denial

ICD Implant (33249) and Q0 Modifier use