# Denial of 33249 with Modifier Q0/Q1



## bcousey26

I've been on the phone with Notivas (Medicare-JH4-MAC) regarding the denial of CPT 33249. According to the rep, the claim was denied as it needs either a Q0 or Q1 modifier, in addition to an medically necessary diagnosis code. 

The medical necessity of the diagnosis code is more than understandable, but I've never and I mean NEVER had to use either a Q0 and/or Q1 on 33249. Is this a new rule? From what information I can gather these modifier are used for clinical research patient-This patient is not under clinical research to my immediate knowledge. 

Is anyone else having to place Q0/Q1 modifier when billing 33249. Where can I locate educational information under CMS or Notivas so that I can inform our charge entry staff. 

This is confusing....Any help is greatly appreciated.


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## twizzle

bcousey26 said:


> I've been on the phone with Notivas (Medicare-JH4-MAC) regarding the denial of CPT 33249. According to the rep, the claim was denied as it needs either a Q0 or Q1 modifier, in addition to an medically necessary diagnosis code.
> 
> The medical necessity of the diagnosis code is more than understandable, but I've never and I mean NEVER had to use either a Q0 and/or Q1 on 33249. Is this a new rule? From what information I can gather these modifier are used for clinical research patient-This patient is not under clinical research to my immediate knowledge.
> 
> Is anyone else having to place Q0/Q1 modifier when billing 33249. Where can I locate educational information under CMS or Notivas so that I can inform our charge entry staff.
> 
> This is confusing....Any help is greatly appreciated.



33249 without a Q0 will deny for MCR(not MCR replacement) patients for whom a Dx of 425.4 or 414.8 is the indication, without an arrythmia such as v tach or whatever being documented. Also, you would not use it for patients where V12.53 is appropriate. It is a modifier used to indicate an ICD was placed for primary prevention of sudden cardiac death. The patients are merely entered into a clinical research database...the patients themselves are not being "researched".
Hope this helps


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## bcousey26

This is extremely helpful. Thank you for the education.


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## twizzle

Pleased to help. It can be confusing and time-consuming trying to figure out why the code was denied.


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## hcg

bcousey26 said:


> I've been on the phone with Notivas (Medicare-JH4-MAC) regarding the denial of CPT 33249. According to the rep, the claim was denied as it needs either a Q0 or Q1 modifier, in addition to an medically necessary diagnosis code.
> 
> The medical necessity of the diagnosis code is more than understandable, but I've never and I mean NEVER had to use either a Q0 and/or Q1 on 33249. Is this a new rule? From what information I can gather these modifier are used for clinical research patient-This patient is not under clinical research to my immediate knowledge.
> 
> Is anyone else having to place Q0/Q1 modifier when billing 33249. Where can I locate educational information under CMS or Notivas so that I can inform our charge entry staff.
> 
> This is confusing....Any help is greatly appreciated.




We also had a denial on a claim and Medicare told us to append modifier Q0/Q1. What was the result of your claim? Did it got paid with modifier Q0/Q1??


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## twizzle

hcg said:


> We also had a denial on a claim and Medicare told us to append modifier Q0/Q1. What was the result of your claim? Did it got paid with modifier Q0/Q1??


The Q0 modifier has been around for several years.

If you have a MCR patient who is having an ICD implanted for the PRIMARY prevention of sudden cardiac death, then you append Q0 to 33249.

In other words, if they have cardiomyopathy (ischemic or non-ischemic) and no arrhythmia such as v-tach, and they have never had a cardiopulmonary arrest with successful resuscitation, they are considered 'at risk' for sudden cardiac death. 

To show this, MCR requires the Q0 in order for the patient to be followed by being entered into a registry to monitor whether the ICD implant was successful in preventing this severe form of arrhythmia and sudden death. It is only for MCR, not MCR replacements, and any claim without the modifier but with the required diagnosis will be denied. 

So 425.4 and all the other non-ischemic cardiomyopathy codes, or 414.8, both without v-tach 427.1, or v-fib 427.41, need Q0.


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## hcg

Thank you so much for the information. We never had this kind of denial before. It helps a lot.


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## twizzle

*33249q0*



wassock said:


> The Q0 modifier has been around for several years.
> 
> If you have a MCR patient who is having an ICD implanted for the PRIMARY prevention of sudden cardiac death, then you append Q0 to 33249.
> 
> In other words, if they have cardiomyopathy (ischemic or non-ischemic) and no arrhythmia such as v-tach, and they have never had a cardiopulmonary arrest with successful resuscitation, they are considered 'at risk' for sudden cardiac death.
> 
> To show this, MCR requires the Q0 in order for the patient to be followed by being entered into a registry to monitor whether the ICD implant was successful in preventing this severe form of arrhythmia and sudden death. It is only for MCR, not MCR replacements, and any claim without the modifier but with the required diagnosis will be denied.
> 
> So 425.4 and all the other non-ischemic cardiomyopathy codes, or 414.8, both without v-tach 427.1, or v-fib 427.41, need Q0.



As a follow-on from this discussion, Medicare now (from 01/01/2014) requires that the code for the clinical registry data be attached to CPT 33249Q0.

 It is an eleven character alphanumeric code and begins with either NCT or NCD I think, followed by eight digits. I guess you could Google it thru MCR and clinical registry to pull up the correct code for the relevant registry. Our data management team have managed to find a way to attach it to our charge on our system(Centricity) so it should be do-able for anyone who codes these procedures regularly.


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## hcg

wassock said:


> As a follow-on from this discussion, Medicare now (from 01/01/2014) requires that the code for the clinical registry data be attached to CPT 33249Q0.
> 
> It is an eleven character alphanumeric code and begins with either NCT or NCD I think, followed by eight digits. I guess you could Google it thru MCR and clinical registry to pull up the correct code for the relevant registry. Our data management team have managed to find a way to attach it to our charge on our system(Centricity) so it should be do-able for anyone who codes these procedures regularly.




Do you guys know what is the NCT number For this code (33249)?


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## brownie

*Eleven character code--- re defib mod Q0*

Does anyone know what the eleven character alphanumeric code is -? I am not ahving any success at looking for it  today -

Thank you-


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## TWilliam2019

*m Q0*

I would like the info   thanks kashyatt@aol.com


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## hcg

hcg said:


> Do you guys know what is the NCT number For this code (33249)?





I finally found the NCT number. Here it is: NCT01999140


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## theresa.dix@tennova.com

wassock said:


> As a follow-on from this discussion, Medicare now (from 01/01/2014) requires that the code for the clinical registry data be attached to CPT 33249Q0.
> 
> It is an eleven character alphanumeric code and begins with either NCT or NCD I think, followed by eight digits. I guess you could Google it thru MCR and clinical registry to pull up the correct code for the relevant registry. Our data management team have managed to find a way to attach it to our charge on our system(Centricity) so it should be do-able for anyone who codes these procedures regularly.


Wassock,
 can you provide me with where I can get this information I have looked and cannot find a thing. 

Thank you


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## cindymcleod_@hotmail.com

bcousey26 said:


> I've been on the phone with Notivas (Medicare-JH4-MAC) regarding the denial of CPT 33249. According to the rep, the claim was denied as it needs either a Q0 or Q1 modifier, in addition to an medically necessary diagnosis code.
> 
> The medical necessity of the diagnosis code is more than understandable, but I've never and I mean NEVER had to use either a Q0 and/or Q1 on 33249. Is this a new rule? From what information I can gather these modifier are used for clinical research patient-This patient is not under clinical research to my immediate knowledge.
> 
> Is anyone else having to place Q0/Q1 modifier when billing 33249. Where can I locate educational information under CMS or Notivas so that I can inform our charge entry staff.
> 
> This is confusing....Any help is greatly appreciated.



Yes we have had to use the q0 for several years.


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## Chlrtrep

The Clinical Trial Number for the ICD Registry is
NCT01999140


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## gravesj

*graves.julie@mcrf.mfldclin.edu*

I have additional questions regarding the billing for the ICD Registry.  I am aware of the requirements for the Q0 Modifier, Z00.6 diagnostic code, and NCT01999140 for the billing for CPT 33249.  Is that the only code that needs to be submitted as such or do the CPT codes for the procedure services related to the ICD require the Q1 modifier?  Does MCR Replacements mean the same thing as Medicare Advantage Plans?  If so, the Q0 modifier does not apply to the billing of the ICD for patients on a Medicare Advantage Plan?


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