Wiki ICD denials

[stephanie465]

Can someone please help!! All of our ICD implants are being denied by Medicare whether we add the Q0 modifier or not with dx code of 425.4. We can't find any LCD/NCD's on our local carrier for Ohio. Anything will be helpful at this point.
Thank you!

 

[kasullivan2]

ICD Denials

I don't know much about Q0-Investigational clinical service provided in a clinical research study that is in an approved clinical research study.

Don't you have to bill with V70.7 as the primary dx code?

You may already know about this but check out the following:



Source: CMS Claims Processing Manual R2052CP
Chapter:
Subject: Pub 100-04 Transmittal R2052CP - Billing and Processing for Healthy Control Group Volunteers in a Qualified Clinical Trial
Version: 2010-09-17 -

This was new as of September last year, so you may already have this information.

 

[stephanie465]

ok. so, let me get this straight..dx codes such as 428.22, 412, 425.4 should be billed as a secondary dx to V70.7 for patients who do not have dx such as 427.1, 427.41 etc... if i'm understanding the transmittal you referenced.
Thanks so much for your help!

 

[maryawinfield04]

for ICD checks I use the V45.02 diagnosis code. the Q0 modifier is usually used just for the initil implant (33249). Diagnosis code 425.4 is usually used as a secondary diagnosis code to a CHF diagnosis (i.e. 428.0).

if this helps any.