Updated Pacemaker Implantation Coding Requirements

Consistent with the updated national coverage determination that took effect in 2013, the Centers for Medicare and Medicaid Services (CMS) has issued updated coding requirements that take effect next month. Starting July 6, claims for these services will only be processed when the KX modifier is included on the claim line as attestation by the provider of the service that documentation is on file verifying the patient has non-reversible symptomatic bradycardia due to sinus node dysfunction, second degree and/or third degree AV block.

Some indications for implantation such as pacemaker syndrome or congenital long QT syndrome are not explicitly addressed in coverage. Other indications, such as “medication-induced” bradycardia, are non-covered despite inclusion in guidelines and comments to CMS during the coverage development process. In these instances, CMS has recommended that providers communicate directly with local Medicare contractors to obtain additional guidance. More information is available from CMS. Thorough documentation will be especially important in these instances.

Clinical Topics: Arrhythmias and Clinical EP, Congenital Heart Disease and Pediatric Cardiology, Implantable Devices, EP Basic Science, Genetic Arrhythmic Conditions, SCD/Ventricular Arrhythmias, Congenital Heart Disease, CHD and Pediatrics and Arrhythmias, CHD and Pediatrics and Quality Improvement

Keywords: Atrioventricular Block, Bradycardia, Centers for Medicare and Medicaid Services (U.S.), Clinical Coding, Documentation, Long QT Syndrome, Medicaid, Medicare, Sick Sinus Syndrome

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