I46.2 — Cardiac arrest due to underlying cardiac condition
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- A face-to-face encounter and a Written Order Prior to Delivery (WOPD) must be documented and obtained prior to delivery for specified HCPCS codes per Final Rule 1713 and the LCD-related Standard Documentation Requirements article.
- The diagnosis code that justifies the medical need for the AED must be included on the claim.
- Suppliers must use the KX modifier only if all LCD criteria are met; use GA if an ABN was obtained when criteria are not met, or GZ if no valid ABN was obtained; failure to use required modifiers will result in claim rejection.
- All claims for codes K0606 and E0617 must include the KF modifier because these codes are FDA Class III devices; absence of KF will result in claim rejection.
Key Coverage Criteria
- Automatic external defibrillators (non-wearable E0617, wearable K0606, and other types A9270) are covered under the Durable Medical Equipment benefit when the reasonable and necessary (R&N) requirements in the related Local Coverage Determination (LCD) and applicable statutory payment requirements are met.
- Medicare Part B covers the professional component of cardiac catheterization and coronary angiography when performed in hospital inpatient and outpatient facility settings.
- Diagnostic cardiac catheterization performed in an office setting (where permitted) is covered under Medicare Part B for both professional and technical components.
- Global and technical component procedures are covered under Part B when performed under personal physician supervision in an IDTF, free-standing facility, physician office, or physician-directed clinic (physician present in room for entire procedure).
- Patients with a personal history of sustained ventricular tachyarrhythmia (sustained VT) or cardiac arrest due to ventricular fibrillation (VF) not associated with an acute myocardial infarction and not due to a transient or reversible cause are covered for ICD implantation.
- Patients with prior myocardial infarction and measured left ventricular ejection fraction (LVEF) ≤ 0.30 are covered for ICD implantation provided they do not have NYHA class IV heart failure, have not had CABG or PCI within the past 3 months, have not had an MI within the past 40 days, and are not clinical candidates for coronary revascularization.
20 Active Policies
A56391 — Billing and Coding: Implantable Automatic Defibrillators
J05
L33577 — Transthoracic Echocardiography (TTE)
J06
A56326 — Billing and Coding: Implantable Automatic Defibrillators
J06
A52850 — Billing and Coding: Cardiac Catheterization and Coronary Angiography
J06
L33557
Related Codes
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