If more than 35 percent of your ICDs are dual-chamber, you could be raising a red flag
The new Medicare coverage decision means more ICDs for the patients who need them, but you should tread carefully if your implanting physician is using more dual chambers rather than single chambers. Both services may warrant the same code - but database information could signal an audit.
Although you can code both single- and dual- chamber devices the same way with 33249 (Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator), your electrophysiologist (EP) should be inserting more single- than dual-chamber ICDs.
"Only two types of patients would be right for dual- chamber ICDs - 1. patients with atrial arrhythmias (so that the atrial lead will help diagnostically and possibly avoid shock therapy) and 2. patients with a bradycardia (427.89). They would only account for around 35 percent of the population," says Eric Prystowski, MD, director of the electrophysiology lab at St. Vincent Hospital in Indianapolis and the editor in chief of the Journal of Cardiovascular Electrophysiology.
Audit signals: Therefore, when the implanting physician enters the patient's information into the database, CMS may be able to tell if the hospital performed 80 percent dual chambers, which would be way over margin and could flag an audit, Prystowski says.
The new Medicare coverage decision means more ICDs for the patients who need them, but you should tread carefully if your implanting physician is using more dual chambers rather than single chambers. Both services may warrant the same code - but database information could signal an audit.
Although you can code both single- and dual- chamber devices the same way with 33249 (Insertion or repositioning of electrode lead[s] for single- or dual-chamber pacing cardioverter-defibrillator and insertion of pulse generator), your electrophysiologist (EP) should be inserting more single- than dual-chamber ICDs.
"Only two types of patients would be right for dual- chamber ICDs - 1. patients with atrial arrhythmias (so that the atrial lead will help diagnostically and possibly avoid shock therapy) and 2. patients with a bradycardia (427.89). They would only account for around 35 percent of the population," says Eric Prystowski, MD, director of the electrophysiology lab at St. Vincent Hospital in Indianapolis and the editor in chief of the Journal of Cardiovascular Electrophysiology.
Audit signals: Therefore, when the implanting physician enters the patient's information into the database, CMS may be able to tell if the hospital performed 80 percent dual chambers, which would be way over margin and could flag an audit, Prystowski says.
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