Ask Dr. Z

Hi Dr. Z, I am having a problem with coding an ICD case. The paient had a single chamber ICD put in for primary protection in 2003. He is back for replacement of his depleted generator, and also an upgrade to a Bi-v ICD due to his worsening CHF (class 111), EF of 29% conduction delay on ekg, with QRS duration of greater than 120. He is an out patient. He received a Bi-v ICD generator, atrial lead and a bi-v lead. I coded 33249, 33241, and 33255. I did not use the Q0 modifier because of the existing ICD and I thought the Q0 was only for new ICD inserts. MR coded 428.22 as the diagnosis code. 33249 hit an edit for a modifier, or addd't diagnosis code. " 33249 requires a modifier, or a diagnosis (per CR3604) must be present if the AICD is for secondary prevention of sudden cardiac arrest. I was told that V53.32 could not be used because of the upgrade. Should I use Q0 to bypass the edit? Thanks, Dr. Z Diane