Wiki 33249 & 33225 denied

[coders_rock!]

33249 - denied
33225 - denied
36005(59) - paid
71090(26) - paid

33249 denied for not having appropriate modifier.
33225 is an add-on code and was denied as not having primary code****33225 can be used w/33249.

Any suggestions?

 

[dpumford]

Hello: What diagnosis was used and was this Medicare?

You may need the Q0 modifier on 33249 if Medicare and there is a list of dx that support the AICD placement that do not require the Q0 modifer.

The DX used for 33225 may not support LV lead placement or it also may be rejecting because the 33249 was rejected.

I believe there are Medicare policies that may be helpful.

Hope this helps!

 

[coders_rock!]

Hello: What diagnosis was used and was this Medicare?

You may need the Q0 modifier on 33249 if Medicare and there is a list of dx that support the AICD placement that do not require the Q0 modifer.

The DX used for 33225 may not support LV lead placement or it also may be rejecting because the 33249 was rejected.

I believe there are Medicare policies that may be helpful.

Hope this helps!

The Dx is 428.22 & it is Medicare. Why would I need to put a Q0 modifier. Per Ingenix, 33249 does not accept that modifier.