Wiki Denials from advantage plans on defibrillator code 33249

[RHSTOVA]

Hi there Coders
I am needing your help figuring out why Advantage plans are denying 33249 saying not a covered Dx (Cardiomyopathy), but is covered through Medicare and is on the NCD.
If anyone knows the answer it would be greatly appreciated.
Thank you
Rhonda S.,CPC

 

[Davieda Skobel]

Denials from advantage plans on defibrillator code 33249.

My guess is that they are looking for the arrhythmia that the patient is having that is causing him/her to need the defibrillator, cardiomyopathy is not normally treated with a defibrillator unless they are having some sort of arrhythmia.Ask the physician for a primary diagnosis and use the cardiomyopathy as a secondary. Make sure the physician implanted a defibrillator and not a pacemaker.

Good Luck
Davieda Skobel CLPN, CPC