# PAcemaker IMplant denials due to claim having ICd-10 code R55 on claim



## Chlrtrep (Jan 19, 2016)

I realize the NCD 20.8.3 for Pacemaker implants  CR9078 states the syncope (R55) is not a covered dx for pacemaker implants.  It also goes on to state that claim will be denied if R55 is present even with a qualifying covered DX code.  I have some concerns regarding this and I am curious if any one else have any other information.  Our billing dept. is removing dx codes from patient that have had a Pacemaker implant and R55 is listed on the claim. In some cases this code is also being removed fro the Admitting DX for the patients encounter.  All pacemaker patients have the correct indications and the correct dx codes for the procedure. However some of these patients did have a syncopal event in addition to other indications.  I am concerned that this dx codes are being removed from the patient's encounter to bill a pacemaker back should they not remain if the patient truly had these events.  I am curious if any one have any additional information


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## mitchellde (Jan 19, 2016)

R55 is a symptom code for a symptom of syncope. Coding guidelines state that if you have the definivitive diagnosis that is the cause of the symptom, you do not code the symptom.  Depending on the documentation it may be correct to not code the R55 code.


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## Chlrtrep (Jan 19, 2016)

mitchellde said:


> R55 is a symptom code for a symptom of syncope. Coding guidelines state that if you have the definivitive diagnosis that is the cause of the symptom, you do not code the symptom.  Depending on the documentation it may be correct to not code the R55 code.



Thank you I see how that makes sense now.  I appreciate your feedback.


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## sjenkins75 (May 9, 2016)

*R55 for Long Term EEG for an IDTF*



Chlrtrep said:


> I realize the NCD 20.8.3 for Pacemaker implants  CR9078 states the syncope (R55) is not a covered dx for pacemaker implants.  It also goes on to state that claim will be denied if R55 is present even with a qualifying covered DX code.  I have some concerns regarding this and I am curious if any one else have any other information.  Our billing dept. is removing dx codes from patient that have had a Pacemaker implant and R55 is listed on the claim. In some cases this code is also being removed fro the Admitting DX for the patients encounter.  All pacemaker patients have the correct indications and the correct dx codes for the procedure. However some of these patients did have a syncopal event in addition to other indications.  I am concerned that this dx codes are being removed from the patient's encounter to bill a pacemaker back should they not remain if the patient truly had these events.  I am curious if any one have any additional information



I was told by BCBS that code is being denied on our claims because it is flagged as an emergency or severe emergency code.  I am trying to find something that explains this.  The BCBS agent told me to ask my coder, problem is that I am the coder so any info that anyone may have would be great.  It just doesn't make sense to deny it for medical necessity because it is an emergency or severe emergency code; to me that screams medical necessity.  If it is being denied for Pacemaker Implants, then who can use it.  

I am sorry I have nothing to help clarify.  

Thank You,
Stacey Davis


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