icd implant cpt code

Billing Guidelines For Implantable Cardioverter Defibrillator (ICD 10 CM)

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)

Append modifier Q0 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.

ICD Implant CPD Code

For CPT codes 33223, CPT 33224, CPT 33225, CPT 33230, CPT 33231, CPT 33240, CPT 33241, CPT 33244, CPT 33249, CPT 33262, CPT 33263, CPT 33264, CPT 33270, CPT 33271, CPT 33272, CPT 33273 & CPT 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 Codes For Implantable Cardioverter Defibrillator

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)

Similar Posts

Leave a Reply

Your email address will not be published.