93000 denied - Does anyone know

coders_rock!

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Good morning,

Has anyone been paid for an EKG (93000) with G0438? I keep getting a denial that the EKG is included in the G0438 code. Why??? Does anyone know????
 

aaron.lucas

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Cherry Hill, NJ
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that's odd, I just ran it up against CCI on both Supercoder and CMS, and both say there's no edit. the only thing that I can think of is that the payer considers the EKG (a diagnostic test) to be an inclusive part of the wellness visit, which I would expect to have some diagnostic tests performed at a visit like that. or maybe they only consider the professional component to be included. did you try billing the tracing only code? I think it's 93005? does any of this make sense? hope I could help! :)
 

jsa1517

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with the G0438 code, it cannot have a modifier 25 on it and the 93000 EKG needs an actual dx code, not the V70.0.. the 93000 also needs modifier 59 on it. hope this helps.. we had a problem but finally figured it out :)
 

sjwillis

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Tupelo, MS
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Medicare covers one EKG screening per lifetime for eligbile Medicare patients. You would file HCPCS code G0403 with dx V70.0. Medicare will deny the 93000 when billed in conjunction with the Medicare Wellness Visits and screening dx. CMS website actually has a whole 300 page manual devoted to their wellness program. You can search "preventative services" and it should lead you right to it.
 

roxvaughn

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93000

Hello,

Does anybody know where we can find an up to date policy for 93000?? Medicare site only seems to have drafts and archived policies.
 
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