Cardiology Question for the Week of June 4, 2018

Posted Posted in Cardiology, Question of the Week

Question:

This is a follow-up to the answer to last week’s (5-29-2018) cardiology question regarding claims for replacement ICDs (implantable cardioverter defibrillators) that were denied because they didn’t have a modifier. The provider asked whether they could request an adjustment for these, and you replied, “Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered (as long as the claim was denied solely because it lacked a QR modifier).”

Don’t you mean a Q0 modifier (investigational clinical service provided in a clinical research study that is in an approved clinical research study)? We have been using Q0 per CMS direction for two years now—ever since our EP program began placing ICDs, and we have had no issues. Please clarify why you believe a QR still applies.

Cardiology Question for the Week of April 23, 2018

Posted Posted in Cardiology, Question of the Week

Question:

We are getting conflicting information on split-shared evaluation and management (E & M) visits in the hospital. The Medicare information I have found says that a consult code cannot be split-shared. But our question is this: If the patient has Medicare and we cannot bill the consult code, can that visit be split-shared if the intent was a consult?