Wiki 93000 and 93040


True Blue
Overland Park, KS
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I have researched this question prior to posting it here, but did not find specific guidance to answer my question, so I am posting my question here......

I have a clinic that wants to report codes 93000 for a routine ECG and 93040 for rhythm ECG, 1-3 leads together. I am curious under what circumstances you would report these two procedures together. I am aware that NCCI Edits bundle 93040 into 93000 and they can be reported separately via modifier 59 appended to code 93040 if the criteria is met, but under what circumstances would you report these two procedures together?

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We only bill the rhythm strip IF there is an order and then physician review with documentation that an EKG is medically necessary after the strip.
93010 and 93042

We are running into the same issue. We have a physician wanting to bill for the 93010 (EKG interpretation) and 93042 (rhythm strip interpretation) and there is is no indication for the rhythm strip. Plus we have found that many payers bundle them together even though they have a modifier indicator that allows one. How are others handling this?