Cardiology Question for the Week of June 4, 2018

Cardiology Compliance 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.

Answer:

You are right that the answer provided included an incorrect modifier, and the answer to the 5-28-2018 question has been corrected. For more on modifier QO, go to the Medicare Claims Processing Manual, Chapter 32, section 270.2 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c32.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.