I am needing some help with Cardiology practice billing CPT 33249 and 33225 for POS 22 to Medicare Part B J5.
The claims are being denied as not medically necessary, decision based on NCD policy online. The policy I found is 20.4 NCD for Implantable Automatic Defibrillators. This policy does not list the codes it covers or the diagnosis codes supported. It does list indications and limitations for coverage for New York Heart Association Classification (NYHC) of heart failure. Are there ICD9 or ICD10 codes for these classifications, or for LVEF of less than 35% other than dilated cardiomyopathy? Does anyone have any success in getting these CPT codes paid by Medicare? Is there a published set of criteria that is used?
Please help me with any suggestions on coding or direction in where to find the policies.
Thanks so much.
The claims are being denied as not medically necessary, decision based on NCD policy online. The policy I found is 20.4 NCD for Implantable Automatic Defibrillators. This policy does not list the codes it covers or the diagnosis codes supported. It does list indications and limitations for coverage for New York Heart Association Classification (NYHC) of heart failure. Are there ICD9 or ICD10 codes for these classifications, or for LVEF of less than 35% other than dilated cardiomyopathy? Does anyone have any success in getting these CPT codes paid by Medicare? Is there a published set of criteria that is used?
Please help me with any suggestions on coding or direction in where to find the policies.
Thanks so much.