New Secondary Prevention Diagnosis for ICD Services

Medicare has added ICD-9-CM diagnosis code V12.53 (effective October 1, 2007) to the list of diagnosis codes the do not require a Q0 modifier for payment for Implantable Cardiac Defibrillator (ICD) services provided in a clinical study.

When CMS expanded coverage for ICDs in January 2005, one of the requirements was for data to be reported by the provider for beneficiaries receiving ICDs for the primary prevention of sudden cardiac arrest.  Modifier QR was required on claims of primary prevention ICDs to indicate the patient was enrolled in a data collection system.  Effective for dates of service on and after January 1, 2008, HCPCS modifier QR was replaced with HCPCS modifier Q0 (zero). 

Patients receiving an ICD for one of several secondary prevention diagnosis codes defined by CMS do not require a modifier Q0 on the claim.  (It should be noted that providers are permitted to append the Q0 modifier for secondary prevention diagnoses if they deem it appropriate, i.e., that data is submitted to a data collection registry.) 

CMS Transmittal 6630 (CR 6867) released March 26, 2010, instructs CMS contractors to add the ICD-9-CM diagnosis code V12.53 (effective October 1, 2007) to the list of diagnosis codes for which either a Q0 modifier (for dates of service on or after January 1, 2008) or a QR modifier (for dates of service prior to January 1, 2008) is not required for payment.

The complete list of diagnosis codes that do not require a Q0 modifier are:

• 427.1 Ventricular tachycardia
• 427.41 Ventricular fibrillation
• 427.42 Ventricular flutter
• 427.5 Cardiac arrest
• 427.9 Cardiac dysrhythmia, unspecified
• V12.53 Personal history of sudden cardiac arrest
• 996.04 Mechanical complication of cardiac device, implant, and graft, due to automatic implantable cardiac defibrillator
• V53.32, Fitting and adjustment of other device, automatic implantable cardiac defibrillator

For more information, view the Transmittal link above or see MLN Matters Article MM6867.