tci Part B Insider - 2006 Issue 2

CARDIOLOGY: Make Sure Documentation Supports ICD-9 Codes For Heart Failure

Carrier cracks down on LV lead placement claimsWhen you're reading your carrier's local coverage determinations, sometimes it's not enough to look at the written list of conditions that the carrier will cover for a particular procedure. Take a lesson from the following case study on left ventricular lead insertion for the purpose of biventricular pacing (33224-33226). Rule: Part B carrier Noridian Administrative Services put out a policy in 2003 stating that it would cover 33224-33226 for patients with "moderate to severe congestive heart failure (CHF)." Patients also must have "an electrical conduction disturbance in the heart that causes...

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