icd 9 code for aicd

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Article Guidance

The National Coverage Determination (NCD) 20.4, Implantable Automatic Defibrillators was revised with an effective date of February 15, 2018. The CMS A/B Medicare Administrative Contractors (MACs) have been instructed to implement the NCD at the local level. The following provides coding and billing instructions for the implementation of NCD 20.4.

ICD-10-CM Codes that Support Medical Necessity

ICD-10-CM codes I25.2, I25.5, I42.0, I42.6, I42.7, I42.8 and Z76.82 must be reported with a secondary diagnosis as described above.

ICD-10-CM Codes that DO NOT Support Medical Necessity

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

Does Medicare cover ICDs?

Medicare only covers ICDs placed for the primary prevention of sudden cardiac death if data is submitted to an FDA-approved category B IDE clinical trial, a trial under the CMS Clinical Trial Policy, or a qualifying data collection system, including approved clinical trials and registries.

Does Medicare cover ICDs for cardiac death?

Although Medicare’s NCD provides coverage criteria for primary and secondary prevention of sudden death, the coverage of the two indications is not the same.#N#Secondary prevention of sudden death is covered, as long as there are no contraindications. Medicare only covers ICDs placed for the primary prevention of sudden cardiac death if data is submitted to an FDA-approved category B IDE clinical trial, a trial under the CMS Clinical Trial Policy, or a qualifying data collection system, including approved clinical trials and registries. CMS selected the American College of Cardiology’s National Cardiovascular Data Registry (ACC-NCDR) ICD Registry as the mandated national registry for ICDs in October 2005. The ClinicalTrials.gov identifier for this data repository is NCT01999140.#N#When an ICD is implanted in the outpatient setting, providers notify Medicare that data is being submitted to the ACC-NCDR, as required in the NCD, by appending modifier Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study to the CPT® code for the implantation procedure. If the performed procedure is for primary prevention of sudden death, and modifier Q0 is not appended, there is no coverage for the ICD implantation.#N#Modifier Q0 is required only when the ICD is implanted for primary prevention of sudden death. Modifier Q0 may be appended to claims for secondary prevention indications (those meeting non-restricted coverage requirements due to clinical indications) when data is being submitted to a data collection system.#N#Although the ACC-NCDR may not meet the expected definition of a clinical trial, the use of modifier Q0 categorizes the procedure as part of a clinical study. When a clinical study is performed, ICD-10-CM Z00.6 Encounter for examination for normal comparison and control in clinical research program typically is required in either the primary or secondary position on the claim.#N#The following items are required when billing for ICDs implanted for primary prevention of sudden death:#N#For hospital outpatient billing, clinical trial registry number 1999140 in the electronic claim equivalent, 837I (Loop 2300 REF02 (REF01=P4) for an 837I claim when a clinical trial claim includes:

What is the primary prevention of sudden cardiac death?

The coverage falls into two major categories: primary prevention of sudden cardiac death and secondary prevention of sudden cardiac death. Primary prevention ICD implantation is to prevent sudden death in a patient who has poor cardiac function and potentially abnormal heart rhythm that could lead to cardiac arrest.

Who is Ruth Broek?

Ruth Broek, MBA, CIRCC, COC, CCS, RTR, CHC, vice president of ZHealth Publishing, is responsible for all support functions, including researching coverage issues, maintaining coding policies, keeping the reference library updated, and maintaining website information. She also performs chargemaster reviews and revenue cycle process improvement for facilities across the country. Broek is a member of the Murfreesboro, Tenn., local chapter.