Device-Intensive Procedure and Device Code Search

Additional Billing Guidance

To prevent and/or correct the edit (reason code W7092), verify the following:

1. The procedure and device code(s) reported on the claim are correct.
2. The procedure/device code(s) are submitted on the same claim with the same date of service.
3. If the procedure was discontinued, a device code is not required, but one of the following CPT modifiers should be reported with the procedure code:
4. • 52 (Reduced services)
   • 73 (Discontinued outpatient procedure prior to anesthesia administration)
   • 74 (Discontinued outpatient procedure after anesthesia administration)
5. If there is no applicable HCPCS code for the device, C1889 (Implantable/insertable device, not otherwise classified) may be reported.
6. For certain device-intensive procedures, providers may bypass the device edit requiring at least one device HCPCS code for the procedure. For situations where no device was performed with certain device-intensive procedures, providers may bypass the edit by reporting HCPCS modifier CG.

References:

• CMS Medicare Claims Processing Manual (Pub. 100-04), chapter 4, sections 61.2 and 61.3.5
• OCE Quarterly Release Files
• CMS MLN Fast Fact, "Cardiac Device Credits: Medicare Billing"