Cardiology Coding Alert

Question: Who should be doing the data summation to the Q-Net? Is it the hospital or the physician?


Texas Subscriber

Answer: You can point the finger at the hospital because the hospital manages and maintains the QualityNet (Q-Net) Exchange connection. But that's the easy way out. You have a liability as well because you have to use modifier QR when you are coding implantable cardio-defibrillator devices (ICD) for the reason of primary prevention.

Medicare patients who receive an ICD or replacement ICD as a primary prevention of sudden cardiac death must be enrolled in a data collection system. Otherwise, Medicare may not cover the procedure. Appending modifier QR to an ICD insertion code (such as 33249, Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator) says that you've submitted this data through the Q-Net process. In other words, using modifier QR says, "The event happened."

If you do know the event happened, you should take the time to figure out who will submit the data, explain to them what these requirements are, and talk to your cardiologists.

In the ideal situation, you'll get a one-page form that the cardiologist fills out before he does the operation, then you'll communicate that form to the Q-Net person, and finally you'll have confirmation that this data has already been submitted before you submit your claim.

FYI: You'll use modifier QR not only for patients meeting the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) coverage criteria but also for Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II patients, and class IV heart failure patients qualifying for cardiac resynchronization therapy.