cpt 93010

aukerp

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I am new to coding and trying to get cpt 93010 reimbursed by medicare for the professional charge not the facility charge. Does this code need a modifier if performed in the ER as the place of service?
 

mhstrauss

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I am new to coding and trying to get cpt 93010 reimbursed by medicare for the professional charge not the facility charge. Does this code need a modifier if performed in the ER as the place of service?

You shouldn't need any modifiers--by definition, this code is for interp and report only. Also, it doesn't have a PC/TC breakdown on the MPFS. Have you received denials for it?
 
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What was the denial? What was the dx that was filed to MCR with 93010? On another note Regarding the mod-When to add a mod(76) to 93010 would be after the first read.
 

Pbhatt1

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Medicare

Medicare does have specific guidelines for ECG billing. It only pays once per year during patient's preventive exam. It does not pay for any visit after that. Please check cms guidelines.
 

aukerp

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Thank you everyone! We established that the 93010 was billed by different facilities and providers. the patient was seen at one ER location then transferred to another ER hospital location in the same day.
 
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Thank you everyone! We established that the 93010 was billed by different facilities and providers. the patient was seen at one ER location then transferred to another ER hospital location in the same day.

We are having an issue with 93010 being denied as "billed by a different provider", but the provider isn't one of ours. We have only billed 93010 once. Can I just slap a modifier 77 on there and assume a different doctor with a different service billed for this interp also? Is modifier 77 appropriate if we have only billed for one? Thanks!
 

CodingKing

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We are having an issue with 93010 being denied as "billed by a different provider", but the provider isn't one of ours. We have only billed 93010 once. Can I just slap a modifier 77 on there and assume a different doctor with a different service billed for this interp also? Is modifier 77 appropriate if we have only billed for one? Thanks!

If you use modifier 77 you are attesting that you know its a repeat procedure. Since you don't know its not appropriate to automatically append it. Usually what this means is someone billed the global code instead of the technical and thus received reimbursement for both components. You might want to check with whoever did the technical component and make sure they didn't bill the wrong code.
 
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