"CPT Copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association.""

Revised Guidelines for Implantable Cardioverter Defibrillator (ICD)


As Per the National Coverage Determination (NCD) for Implantable Automatic Defibrillators (20.4) . CMS mandates that providers bill the Q0 modifier for all primary prevention diagnosis codes to ensure that claims are reported appropriately to the registry. Modifier Q0 is not required to be appended for secondary prevention. (Secondary prevention codes are listed below the table)

Q0 - Append this modifier on a category B IDE code (e.g. CPT 33249- Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber) if data is submitted to an FDA-approved category B IDE clinical trial, a trial under the CMS Clinical Trial Policy, or a qualifying data collection system, including approved clinical trials and registries.

Modifier Q0 is only required when the ICD was implanted for primary prevention of sudden cardiac death. If the ICD procedure was performed for primary prevention, and modifier Q0 is not appended, coverage for the ICD implantation cannot be established and the service will be denied.

For CPT codes 33223, 33224, 33225, 33230, 33231, 33240, 33241, 33244, 33249,33262, 33263, 33264, 33270, 33271, 33272, 33273 & G0448 the claim must be reported with a secondary diagnosis as described below,
  • ICD-10-CM code I25.2, I25.5, I42.0, I42.6, I42.7 or I42.8 must be billed with one of the following ICD-10-CM codes I50.21, I50.22, I50.23, I50.41, I50.42 or I50.43 (Secondary)
  • ICD-10-CM code Z76.82 must be billed with ICD-10-CM code I50.84 (Secondary)
ICD-10 CODE DESCRIPTION

I25.2 Old myocardial infarction
I25.5 Ischemic cardiomyopathy
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I45.6 Pre-excitation syndrome
I45.81 Long QT syndrome
I45.89 Other specified conduction disorders
I46.2 Cardiac arrest due to underlying cardiac condition
I46.9 Cardiac arrest, cause unspecified
I47.2 Ventricular tachycardia
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.3 Ventricular premature depolarization
I49.9 Cardiac arrhythmia, unspecified
I50.21 Acute systolic (congestive) heart failure 
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.84 End stage heart failure
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.129A Displacement of unspecified cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial encounter
Z00.6 Encounter for examination for normal comparison and control in clinical research program
Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator
Z76.82 Awaiting organ transplant status
Z86.74 Personal history of sudden cardiac arrest

***ICD-10-CM codes I25.2, I25.5, I42.0, I42.6, I42.7, I42.8 and Z76.82 must be reported with a secondary diagnosis as described above. ***

Secondary Prevention of Sudden Cardiac Death:

I47.0 Re-entry Ventricular Arrhythmia
I47.2 Ventricular Tachycardiaselect
I49.3 Ventricular Premature depolarization
I49.01 Ventricular Fibrillation
I49.02 Ventricular Flutter
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I49.9 Cardiac arrhythmia, unspecified
T82.110A Breakdown (mechanical) of cardiac electrode, initial encounter
T82.111A Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
T82.118A Breakdown (mechanical) of other cardiac electronic device, initial encounter
T82.119A Breakdown (mechanical) of unspecified cardiac electronic device, initial
encounter
T82.120A Displacement of cardiac electrode, initial encounter
T82.121A Displacement of cardiac pulse generator (battery), initial encounter
T82.128A Displacement of other cardiac electronic device, initial encounter
T82.129A Displacement of unspecified cardiac electronic device, initial encounter
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.191A Other mechanical complication of cardiac pulse generator (battery), initial
encounter
T82.198A Other mechanical complication of other cardiac electronic device, initial
encounter
T82.199A Other mechanical complication of unspecified cardiac device, initial encounter
Z86.74 Personal history of sudden cardiac arrest
Z45.02 Encounter for adjustment and management of automatic implantable cardiac
defibrillator

When any of the above codes appear on a claim, the Q0 modifier is not required

References:

NCD 20.4 Implantable Cardiac Defibrillators (ICDs)

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ncd103c1_Part1.pdf

https://med.noridianmedicare.com/documents/10546/7933826/Implantable+Automatic+Defibrillators+Coding+and+Billing

Blogger Widget

Popular Posts