Wiki implantable defibrillator guidelines

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unikirin

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I have been having issues with my implantable defibrillator codes, specifically 33206-33208 with claims coming back as missing modifiers, the cms guidelines for these procedures links to the following page

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM8525.pdf

however it states that these guidelines are not yet implemented until further notice. So that begs the question as to what guidelines for reporting should I be following? Is anyone else having issues with regard to missing modifiers? From what I understand some providers are requesting Q0 (zero) and some KX? I am fairly new to cardiology and this has been one of my more difficult issues to find a straight answer with. Any relevant information would be greatly appreciated, for the record I am working with providers based in New York city specifically Manhattan so there are no relevant LCD guidelines for New York for these procedures.
 
unikirin said:
I have been having issues with my implantable defibrillator codes, specifically 33206-33208 with claims coming back as missing modifiers, the cms guidelines for these procedures links to the following page

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/MM8525.pdf

however it states that these guidelines are not yet implemented until further notice. So that begs the question as to what guidelines for reporting should I be following? Is anyone else having issues with regard to missing modifiers? From what I understand some providers are requesting Q0 (zero) and some KX? I am fairly new to cardiology and this has been one of my more difficult issues to find a straight answer with. Any relevant information would be greatly appreciated, for the record I am working with providers based in New York city specifically Manhattan so there are no relevant LCD guidelines for New York for these procedures.
Click to expand...

Hi,
33206-33028 are pacemakers

33249 is the defibrillator code

The KX modifier only applies to the pacemaker codes and the Q0 only applies to the defibrillator code.And both are for use with certain dx codes.

So you would not have to worry about the Q0 use on the 33026-33028 codes.
And you would not have to worry about the KX on the defibrillator code.

I dont know any modifier that you would have to use on codes 33026-08.
You are right the KX modifier has been delayed for now and it could be that they were ready to implement and havent taken that into consideration. Which insurance is it? The KX and the Q0 only for Medicare.
 
theresa.dix@ethc.com said:
Hi,
33206-33028 are pacemakers

33249 is the defibrillator code

The KX modifier only applies to the pacemaker codes and the Q0 only applies to the defibrillator code.And both are for use with certain dx codes.

So you would not have to worry about the Q0 use on the 33026-33028 codes.
And you would not have to worry about the KX on the defibrillator code.

I dont know any modifier that you would have to use on codes 33026-08.
You are right the KX modifier has been delayed for now and it could be that they were ready to implement and havent taken that into consideration. Which insurance is it? The KX and the Q0 only for Medicare.
Click to expand...

I have a really bad habit of confusing the defibrillators and the pacemakers, however your information was in fact helpful anyway. These were mostly Medicare cases with a few cases from EMPIRE BCBS and Medicaid.
 
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