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Medical Coding News Archives

New Diagnosis Code Added to Defibrillator Claim Edits

April 22, 2010:

Currently, the agency requires that patients who are treated with an implantable cardiodefibrillator (ICD) be enrolled in a data collection system. This can be indicated on the claim with modifier Q0 (zero), which informs Medicare contractors that the service is being covered under a clinical study. CMS instructed its contractors to create an edit that requires modifier Q0 on ICD claims billed for patients receiving a defibrillator for new indications or for any other primary prevention indication (i.e., no history of induced or spontaneous arrhythmias). The edit is used to check for the absence of a secondary prevention diagnosis code: if the diagnosis code was other than one of these secondary diagnosis codes, then modifier Q0 is required for the services to be covered.

In other words, if one of these secondary diagnosis codes appears on the claim, modifier Q0 is not required. However, it should be noted that providers are permitted to append modifier Q0 for secondary prevention diagnoses if they deem it appropriate; in other words those data are submitted to a data collection registry.

Currently, CMS identifies claims through the procedure code for defibrillator implantation and the absence of five specified arrhythmia codes and two codes often used when the device is being replaced. Recently, CMS has added code V12.53 Personal history of sudden cardiac arrest to this list, bringing the total number of diagnosis codes to eight. All the applicable diagnosis codes that do not require the use of modifier Q0 are listed below:

427.1 Ventricular tachycardia
427.41 Ventricular fibrillation
427.42 Ventricular flutter
427.5 Cardiac arrest
427.9 Cardiac dysrhythmia, unspecified
V12.53 Personal history of sudden cardiac arrest
996.04 Mechanical complication of cardiac device, implant, and graft, due to automatic implantable cardiac defibrillator
V53.32 Fitting and adjustment of other device, automatic implantable cardiac defibrillator

Deborah C. Hall
Clinical/Technical Editor

Key Terms: data collection system, indications, ICD implantations


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