Wiki 93000 "Procedure code is inconsistent with the patient's age?"

[cris722]

The office I work at is Internal Medicine and this is my problem.

Insurance is Humana and the patient is a 26 year old female.

The following was billed.


99395, 80050, 93000, 83036-QW all with diagnosis code Z00.00.

All were paid except the EKG 93000. It states "The procedure code is inconsistent with the patient's age."

Any advice would be greatly appreciated. Thank you.

 

[mitchellde]

I believe the dx is the problem.. you would need a dx for the reason for the EKG.. if it is for screening use the Z13.6 for the screening and if there are relevant family history use those as well. Be aware that many payers do not include EKG screenings as a covered preventive benefit, so be sure the patient checks with the carrier.

 

[cris722]

Thank you so much.