T82.111A — Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter
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.
- Transesophageal echocardiography (TEE) is indicated when transthoracic echocardiography (TTE) provides inadequate visualization of cardiac anatomy for structures normally visualized by TTE; report ICD-10-CM R93.1 or R93.8 as the primary diagnosis and the cardiac abnormality as a secondary diagnosis.
- TEE is indicated when performed during an open chest (intraoperative) procedure; report ICD-10-CM Z01.89 as the primary diagnosis and the reason for the surgical procedure as the secondary diagnosis.
- Use CPT 93315, 93316, or 93317 for evaluation of congenital cardiac anomalies (these codes are reserved for congenital anomalies only).
- CPT 93355 is indicated to report TEE services performed during transcatheter intracardiac therapies and includes probe passage, image acquisition/interpretation, intra-procedural manipulation to guide sizing/placement, assessment of adequacy and complications, and final report.
- 3D imaging (CPT 93319) and CT/MR fusion or related add-on imaging (CPT 76376, 76377) are allowable when billed as add-on services with their listed base TEE imaging codes.
20 Active Policies
A56391 — Billing and Coding: Implantable Automatic Defibrillators
J05
A56781 — Billing and Coding: Transthoracic Echocardiography (TTE)
J06
L33579 — Transesophageal Echocardiography (TEE)
J06
L33577 — Transthoracic Echocardiography (TTE)
J06
A52868
Related Codes
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