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MODIFIER 33208??

Kimberly Posted Tue 14th of July, 2015 12:12:26 PM

We have recently had multiple denial ( five separate claims/patients)for pacemaker insertion code 33208 being denied CO-4 procedure code is inconsistent with modifier used or required modifier is missing. All these claims/denials are from Medicare payer.

We billed 33208 with 427.81 as diagnosis I am unaware of any modifier required for this service. Please advise is any modifier required

thank you

SuperCoder Answered Wed 15th of July, 2015 04:51:59 AM

Well, for CPT 33208 CMS says- effective for claims with dates of service on or after August 13, 2013, MACs shall pay for implanted permanent cardiac pacemakers, single chamber or dual chamber, for the CPT code if the claim contains at least one of the designated diagnosis codes in addition to the –KX modifier. For further details please check the following link-
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM9078.pdf

Hope it helps!

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