Cardiology Question for the Week of May 28, 2018

Cardiology Compliance Question of the Week

Question:

We have had claims for replacement ICDs denied because they didn’t have a modifier. Can we request an adjustment for these?

Answer:

Yes, you may request an adjustment for claims for any date of service for which the replacement ICD was otherwise covered.

Note also that, in February 2018, the Centers for Medicare & Medicaid Services (CMS) decided that ICDs no longer need modifier Q0 as the data-collection requirement is no longer needed. The updated national coverage determination with the requirements can be found at https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=288&TimeFrame=7&DocType=All&bc=AAAAIAAAQAAA&. See also https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3204CP.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.