93000 and 93040 - work for a primary care office

aopicka

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Hello All,
I work for a primary care office and we recently hired a new doctor. She has advised that her old practice would bill both the 93000 (EKG with interpretation and report) and the 93040 rhythem ECG.
These two codes are being used when a patient presents with chest pain and a EKG is done, the provider notices an abnomality and wants to see more of the heart rythem (3 sheets are produced and interpreted)
Has anyone had any luck with billing both of these codes out. I have received a deinal stating the 93040 was part of the 93000. Is there a modifier I am missing?
Documentation shows there was a need to look further.
Thanks for any feedback.
 

dloranger

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I wonder what order the doctor is doing these ekg's. Seems like you'd get more info from the 12 lead ekg (93000) then from a 1-3 lead ekg (93040). So my guess would be the 93040 first and then the 93000. Normally, the denial is correct that the 93040 is an intregal part of the 93000. CCI Edits does bundle 93040 into 93000. But it does show that you could use a modifier to override that bundle. So, if they are indeed two separate tests/ekgs, then you could use a 59 modifier.
 

aopicka

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Thank you

Thank you for your response. This has been driving me insane.
The doc is doing the EKG first and then deciding that they would like a further look at the specfic heart rhythms. The answer I got from the doctor as for the need of both was the rhythm strip (93040) provides 3 pages, and the doc can look at the rhythms for a longer period of time, where as the 93000 only gives one sheet.

Thanks for the info on the bundle and modifier. I will appeal with the appeal and see how this goes.

Again thank you so much

:D
andrea
 

lupita70

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Hi there,

I have a provider that is billing 99285 and 93040 and is being denied as inclusive to E/M. I check CMS CCI edits and I dont see anything that will deny that?

Can you assist me?
 
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