# New Icd Implants with modifier Q0



## yvette31 (Mar 6, 2008)

Hi everyone, I was wondering if anyone who is billing a new Icd placement with the Q0 are recieving payment from medicare? and how you are billing?
I really dont feel comfortable using this modifier on a patient who is not in a study. The  discription states (Investigational clinical service provided in a clinical research study) Medicare is asking for a modifier and a IDE# .I have read in the Cardiology pink sheet that  we should use Q0 as we would of used the QR. Which I did but we recieved a development letter asking for a IDE#. I would like to know what you all think.


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## Lisa Bledsoe (Mar 7, 2008)

It is my understanding that the Q0 is used not only for research studies, but can also be used to indicate that the device is logged into the National Cardiovascular Data Registry, as was indicated with QR.  Is this incorrect?


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## patricia iverson (Mar 7, 2008)

We've running into the same situation.  I've see that Terry Fletcher has an upcoming teleconference on Pacers/ICD's where she is going to go over Diagnosis coding and the QR modifier.  I wouldn't think that this would be a topic if the QR modifier no longer exists.  I would think that the topic would be the new Q0 modifier and it's use.  I'm thinking that you may use Q0 for the trials in place of QA & QR (which were both required) and maybe the QR for the primary prevention ICD's.  I guess I'll have to listen to the teleconference to find out for sure as I haven't been able to find any current info. on the Medicare web site regarding this change.


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## yvette31 (Mar 7, 2008)

*QO Modifier*

Thanks for your reply.Since my posting I have done some research and Yes that is correct Q0 is to be used to signify when they log ICD implant into National Cardivascular Data Registry. I was told in order to get paid we must have a registry number. So I have called the hospitals that my physicians performs these procedures and got a registry number I haven't recieved any response from medicare. I hope the registry number I recieved from the hospital is what they want. I'll keep you all informed.

Thanks.


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## mmorningstarcpc (Mar 18, 2008)

Modifier QO is ONLY used for devices actually in clinical trials.


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## grazide (Apr 9, 2008)

The IDE# they are looking for should show on the claim in the description field and be billed under revenue code 624 for the investigational device; there is guidance in the Medicare Claims processing manual; this revenue code can be set to print the CDM description in your billing system


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## Davistm (Apr 22, 2008)

The ICDs in question are those implanted in MADIT II and SCD-HeFT patients. Implantation criteria [DX and counter indications] for these patients can be found in CMS Publication 100-3, Part 1, Chapter 1, Section 20.4 [indications effective for DOS on or after October 1, 2003 and on or after January 27, 2005].  This document communicates written coverage guidance, not ICD-9 codes.  In general the primary DX for MADIT II patients should be heart failure or a prior MI - not an arrhythmia.  For SCD-HeFT patients, the primary DX should be heart failure or cardiomyopathy - not an arrhythmia. 

The facility at which the implantation is performed is responsible for adding the patient to the national database.  If this is not accomplished, neither the physician nor the facility will be reimbursed.  Physician claims for ICD implantation in MADIT II and SCD-HeFT patients must be reported with modifier Q0 [that is Quebec Zero - not Quebec Omaha].  If your carrier or MAC requires the physician to report a national registration number, then follow their guidance.

Another twist - although modifier Q0 became availale on 01/01/2008, some carriers/MACs [TrailBlazer] made its use effective on 04/07/2008. Those carriers/MACs expected claims submitted before that date to continue use of modifier QR [claims denied with B5 CARC].  

Terry


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