Reason Code: 59301

Error Description:

This inpatient (11X) claim contains one or more procedure codes indicating an implantable cardioverter defibrillator was inserted; however, one or more diagnosis codes required for coverage are missing. Therefore, the provider is liable. 

Avoiding/Correcting This Error

You have the right to submit an appeal when you believe the medical records support that the denied services were reasonable and medically necessary.

To prevent similar denials, ensure that all coverage guidelines are documented and met prior to billing.

Related Content

• National Coverage Determination (NCD) 20.4 Implantable Cardiac Defibrillators (ICDs)
• Centers for Medicare and Medicaid Services Internet-Only Manual 100-03, Medicare NCD Manual, Chapter 1, Part 1, Section 20.4 ICDs
• Change Request 13390 contains a downloadable spreadsheet (zip file) with ICD-10-PCS and ICD-10-CM coding applicable to NCD 20.4