Billing and Coding: Implantable Automatic Defibrillators - R1-Correct Diagnosis Codes and Clarified 45-Day Notice

Note: This revised article corrects diagnosis codes I25.4, I42.26, I42.27 and I48.28 to I25.5, I42.6, I42.7 and I42.8 respectively and clarifies the effective date of this update to the article is October 1, 2019 and November 25, 2019 ends the 45-day notice to providers indicating both a primary and secondary diagnosis listed below are required for payment.

The coverage requirements for the Implantable Automatic Defibrillators National Coverage Determination (NCD) have been revised and published under contract numbers: 02102 (AK) 02202 (ID) 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

NCD: Implantable Automatic Defibrillators 20.4
Effective Date: October 1, 2019
Summary of Article Changes: Effective October 1, 2019 the title of the article was changed from "Implantable Automatic Defibrillators – Coding and Billing" to "Billing and Coding: Implantable Automatic Defibrillators".

To provide providers with a 45-day notice, effective November 25, 2019, diagnosis codes will require one primary and one secondary diagnosis code from the lists below to be payable.

  • Primary:
    • I25.2 - Old myocardial infarction
    • I25.5 - Ischemic cardiomyopathy
    • I42.0 - Dilated cardiomyopathy             
    • I42.6 - Alcoholic cardiomyopathy
    • I42.7 - Cardiomyopathy due to drug and external agent
    • I42.8 - Other cardiomyopathies
  • Secondary:
    • I50.21 - Acute systolic (congestive) heart failure
    • I50.22 - Chronic systolic (congestive) heart failure
    • I50.23 - Acute on chronic systolic (congestive) heart failure
    • I50.41 - Acute combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.42 - Chronic combined systolic (congestive) and diastolic (congestive) heart failure
    • I50.43 - Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • Also, the primary diagnosis code Z76.82 - Awaiting organ transplant status requires I50.84 - End stage heart failure as the secondary diagnosis code.

Visit the National Coverage Determination (NCD) webpage to view the locally hosted NCD coverage requirement articles.  

To access a complete list of CMS NCDs, visit the National Coverage Determinations (NCDs) Alphabetical Index.

Last Updated Dec 03, 2019