Wiki Denial on 93018

If all you are doing is reading the test, you don't bill for performing the test, which is what it looks like you are doing from your question.

On any test that has a technical and a professional component, if you perform the professional component only, you have to produce a report and add the modifier.

If someone else is performing the professional component, and you're just reviewing it with the patient, it's part of the E&M.
 
If all you are doing is reading the test, you don't bill for performing the test, which is what it looks like you are doing from your question.

On any test that has a technical and a professional component, if you perform the professional component only, you have to produce a report and add the modifier.

93018 is for the interpretation and report only, not for performing the test.
 
Patient had an initial visit in the hospital and while in the hospital they had a stress test. So the way we billed it was 99223-25 and on a separate claim billed the 93018. I feel Humana is incorrect on their denial.
 
What do you mean "on a separate claim"? It should have all gone on one claim. What was different about the claim that caused you to separate it?

Did the hospital bill the global code? If so, that might be the problem. Was the ordering doctor's name on the claim (even if it is the same as the performing doctor)? Was the patient inpatient or in the ER? (Some insurances, such as some of the Blues, won't pay for that code in the ER).
 
They way our system works because 2 different individuals keyed they went on separate claims.

Patient was inpatient.

Humana denied the 99223 and paid the 93018.
 
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