Wiki 93237 eVOLUTION CARDIAC EVENT MONITOR

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melissa10000

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Our physican is in Arizona, and has begun billing for professional component of eVOLUTION cardiac event monitor. The rep indicated that the reading could be billed daily up to 30 days, and we have done this, by billing 93237. However, UHC is denying after 2 days for medical necessity. Noridian, our Medicare MAC, requires billing this professional component with 93799-26, with 1 unit and the date span in additional info, along with a total charge for all days the monitor is read.

Is anyone billing for this devise, and if so, how have you been billing for it, and have you been getting reimbursed? I cannot find any billing guidelines other than Noridian.

Sorry for the length of this message, would appreciate any help.
 
melissa10000 said:
Our physican is in Arizona, and has begun billing for professional component of eVOLUTION cardiac event monitor. The rep indicated that the reading could be billed daily up to 30 days, and we have done this, by billing 93237. However, UHC is denying after 2 days for medical necessity. Noridian, our Medicare MAC, requires billing this professional component with 93799-26, with 1 unit and the date span in additional info, along with a total charge for all days the monitor is read.

Is anyone billing for this devise, and if so, how have you been billing for it, and have you been getting reimbursed? I cannot find any billing guidelines other than Noridian.

Sorry for the length of this message, would appreciate any help.
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Hello.

Are you billing for ACT aka wearable mobile cardiovascular telemetry event monitor? if so, 93228 is a new code for 2009 reported once every 30 days. These type of event monitors are a pain in the -----. Anyway, for 2008 we would bill 93237 each day pt wore the monitor, most insurance plans would pay for the daily billing. It was hit and miss with UH. We would send in copies of the daily transmission reports to appeal their denials. We never received payment billing 93799-26 with or w/o a date range. We rec'd payment from Medicare and Medi-caid when we billed with 93237.

As far as I know, we have been paid billing 93228 once every 30 days. I would ask your rep why they suggested billing 93237 or 93799 when there is a new code for these monitors.

I hope this has helped,

Dolores, CPC-CCC
 
Good luck with this billing...one little correction. the type of event monitor is known as MCOT. ACT or Lifestar are the more common models in use.

dolores
 
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