(Medicare Claims Processing Manual)

A diagnosis code for a comorbidity of depression may also be required for coverage on an outpatient and/or inpatient basis as determined by the individual Medicare contractors policy.  260.2.2  Practitioner Billing Instructions  (Rev. 11021; Issued: 10-01- 21; Effective: 10 -29-21; Implementation: 10-29-21)  Practitioners must bill covered claims for dermal injections for treatment of facial LDS by having all of the required elements on the claim:  Performed in a non- facility setting :   A line with HCPCS codes Q2026 or Q2027 with a LIDOS on or after March 23, 2010,    NOTE : Q2027 is replaced with Q2028 effective 1/1/14 per the 2014 HCPCS update.   A line with HCPCS code G0429 with a LIDOS on or after March 23, 2010,   51 If ICD -10-CM applies, diagnosis codes B20 Human Immunodeficiency Virus (HIV) disease and E88.1 (Lipodystrophy not elsewhere  classified). Both diagnoses are required on the claim.   NOTE: A diagnosis code for a comorbidity of depression may also be required for coverage based on the individual Medicare contractors policy.     52 A line with HCPCS code G0429 with a LIDOS on or after March 23, 2010,   53 If ICD -10 CM - applies, ICD -10-CM diagnosis codes B20 Human immunodeficiency Virus (HIV) disease and E88.1 (Lipodystrophy not elsewhere  classified). Both diagnoses are required on the claim.   NOTE: A diagnosis code for a comorbidity of depression may also be required for coverage based on the individual Medicare contractors policy.   260.3  Claims Processing System Editing  (Rev. 11021; Issued: 10- 01-21; Effective: 10 -29-21; Implementation: 10 -29-21)  Billing for Services Prior to Medicare Coverage   Hospitals and practitioners billing for dermal injections for treatment of facial LDS prior to the coverage date of March 23, 2010, will receive the following messages upon their Medicare denial:    Claim Adjustment Reason Code (CARC) 26: Expenses incurred prior to coverage.    NOTE: Outpatient hospitals and beneficiaries that received services in a hospital outpatient setting may receive different message as established by their particular Medicare contractor processing the claim.)    Medicare beneficiaries whose provider bills Medicare for dermal injections for treatment of facial LDS prior to the coverage date of March 23, 2010, will receive the following Medicare Summary Notice (MSN) message upon the Medicare denial:    - This service was not covered by Medicare at the time you received it. (Spanish Version: Este servicio no estaba cubierto por Medicare cuando usted lo recibi .)  Billing for Services Not Meeting Comorbidity Coverage Requirements   Hospitals and practitioners billing for dermal injections for treatment of facial LDS on patients that do not have a comorbidity of HIV and lipodystrophy (or even depression if deemed required by the Medicare contractor) will receive the following messages  upon their Medicare denial:    CARC 50: These are non -covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if  present.    RARC N386: This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the  NCD.    RARC M64: Missing/incomplete/invalid other  diagnosis.   Group Code: CO   Medicare beneficiaries who do not meet Medicare comorbidity requirements of HIV and lipodystrophy (or even depression if deemed required by the Medicare contractor) and whose provider bills Medicare for dermal injections for treatment of facial LDS will receive the following MSN message upon the Medicare denial:   15.4 -  The information provided does not support the need for this service or item. (Spanish Version: La informacin proporcionada no confirma la necesidad para este servicio oculo.)   270  Claims Processing for Implantable Automatic Defibrillators  (Rev. 2005, Issued: 7- 23-10, Effective: 8 -31-10, Implementation: 8- 31-10)  Coverage Requirements - The implantable automatic defibrillator is an electronic device designed to detect and treat life threatening tachyarrhythmias.  The device consists of a pulse generator and electrodes for sensing and defibrillating.   See 20.4 - Medicare National Coverage Determinations (NCD) Manual for the complete list of covered indications.   270.1  Coding Requirements for Implantable Automatic Defibrillators  (Rev.  2998, Issued: 07- 25-14, Effective: Upon implementation of ICD -10; 01- 01-12 - ASC X12, Implementation: 08- 25-2014 -  ASC X12; Upon Implementation of ICD -10)  The following are the applicable HCPCS procedure codes for implantable automatic defibrillators:  33240-  (Insertion of single or dual chamber pacing cardioverter -defibrillator pulse generator)  33241(Subcutaneous removal of single or dual chamber pacing cardioverter -defibrillator pulse generator)  33243 (Removal of single or dual chamber pacing cardioverter -defibrillator electrode(s); by thoracotomy)  33244 (Removal of single or dual chamber pacing cardioverter -defibrillator electrodes by transvenous extraction)  33249-  (Insertion or repositioning of electrode leads(s) for single or dual chamber pacing cardioverter -defibrillator and insertion of pulse generator)   For inpatient hospitals claims, if ICD -9 CM is applicable use procedure code 37.94.  If ICD -10-PCS is applicable the following applies.   More than one ICD -10-PCS code (a cluster) is required. There are two possible clusters:  FIRST CLUSTER:  Use 1 code from the first list and one code from the second list.  Cluster 1 first list:  0JH608Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach  0JH638Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach  0JH808Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach  0JH838Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach  Cluster 1 second list:  02H60KZ Insertion of Defibrillator Lead into Right Atrium, Open Approach 02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach  02H64KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Endoscopic Approach  02H70KZ Insertion of Defibrillator Lead into Left Atrium, Open Approach 02H73KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Approach  02H74KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Endoscopic Approach  02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach  02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach  02HK4KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Endoscopic Approach  02HL0KZ Insertion of Defibrillator Lead into Left Ventricle, Open Approach 02HL3KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Approach  02HL4KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Endoscopic Approach  SECOND CLUSTER:  Use 1 code from 1st list & 1 code from the 4th list; also add one code from each of the 2nd & 3rd lists if doing a replacement instead of initial insertion.  Cluster 2 first list:  0JH608Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Open Approach  0JH638Z Insertion of Defibrillator Generator into Chest Subcutaneous Tissue and Fascia, Percutaneous Approach  0JH808Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Open Approach  0JH838Z Insertion of Defibrillator Generator into Abdomen Subcutaneous Tissue and Fascia, Percutaneous Approach  Cluster 2 second list:  0JPT0PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Open Approach  0JPT3PZ Removal of Cardiac Rhythm Related Device from Trunk Subcutaneous Tissue and Fascia, Percutaneous Approach  Cluster 2 third list:  02PA0MZ Removal of Cardiac Lead from Heart, Open Approach  02PA3MZ Removal of Cardiac Lead from Heart, Percutaneous Approach  02PA4MZ Removal of Cardiac Lead from Heart, Percutaneous Endoscopic Approach  02PAXMZ Removal of Cardiac Lead from Heart, External Approach  Cluster 2 fourth list:  02H60KZ Insertion of Defibrillator Lead into Right Atrium, Open Approach 02H63KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Approach  02H64KZ Insertion of Defibrillator Lead into Right Atrium, Percutaneous Endoscopic Approach  02H70KZ Insertion of Defibrillator Lead into Left Atrium, Open Approach  02H73KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Approach  02H74KZ Insertion of Defibrillator Lead into Left Atrium, Percutaneous Endoscopic Approach  02HK0KZ Insertion of Defibrillator Lead into Right Ventricle, Open Approach  02HK3KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Approach  02HK4KZ Insertion of Defibrillator Lead into Right Ventricle, Percutaneous Endoscopic Approach  02HL0KZ Insertion of Defibrillator Lead into Left Ventricle, Open Approach 02HL3KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Approach  02HL4KZ Insertion of Defibrillator Lead into Left Ventricle, Percutaneous Endoscopic Approach   270.2  Billing Requirements for Patients Enrolled in a Data Collection System  (Rev.11759, Issued:12- 21-2022, Effective:01 -23-2023, Implementation:01- 23-2023)   Effective for dates of service on or after April 1, 2005, Medicare required that patients receiving a defibrillator for the primary prevention of sudden cardiac arrest be enrolled in a qualifying data collection system.  Providers shall use modifier Q0 to identify patients whose data is being submitted to a data collection system.   The following diagnosis codes identify non -primary prevention (secondary prevention) patient or replacement implantations (e.g. due to recalled devices):   If ICD -9-CM is applicable, select from the following diagnosis codes:   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