Health Information Management

Healthcare News: CMS instructs FIs/MACs to hold certain claims for missing device edit

JustCoding News: Outpatient, May 2, 2012

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CMS instructed fiscal intermediaries (FI) and Medicare Administrative Contractors (MAC) to hold claims containing CPT® code 33249 (insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead[s], single or dual chamber) and HCPCS code C1882 (cardioverter-defibrillator, other than single or dual chamber [implantable]).

The procedure-to-device edit files included in the January 2012 and April 2012 Integrated Outpatient Code Editor (I/OCE) do not allow the device described by the HCPCS code C1882 to satisfy the edit in place for CPT code 33249, according to an April 10 message on the CMS listserv.

CMS plans to include a new edit in the July 2012 I/OCE updated that will allow providers to bill HCPCS code C1882 with CPT code 33249.

CMS instructed contractors to hold until July 2 those claims with dates of service between January 1 and June 30 for HCPCS code C1882 used along with CPT code 33249, so these claims may be processed for payment.



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