Watchman Procedure and Chronic AFib
I was wondering if anyone else has seen any Medicare denials for a Watchman procedure because the primary dx code is Chronic Atrial Fibrillation I48.20. We are wondering if:
- This is a mistake on Medicare's part since the code was updated from I48.2 to I48.20 and they just don't recognize the extra digit OR
- Chronic Atrial Fibrillation I48.20 isn't covered for a Watchman Procedure, it has to be persistent or paroxysmal
Please let me know if you all have any insight.
Sarah Wicks, RN, MS, MBA
Clinical Documentation Improvement Program Manager
Utilization Management | Strong Memorial Hospital
Comments
Yes, we have seen these denials. We have tried to appeal with Medicare and they would not change their minds of allowing I48.20. I did some education with the providers performing the procedure and now they are being more specific to include covered diagnoses. I48.91, I48.21, I48.0, I48.11, I48.19. Technically, I48.20 is covered per their reimbursement guide, but Medicare has not yet expanded to include this code, so we also are seeing denials.
https://www.bostonscientific.com/content/dam/watchman/downloads/download-center/WATCHMAN_Reimbursement_Guide.pdf