Wiki E/M codes with EKG

[bnockis]

Good morning!

I'm fairly new to this, so still trying to perfect everything. I work for a family practice. Patient is here for an annual physical and has a new c/o right hip pain, for which she is being referred to an Ortho for a second opinion. Pt also had an EKG for palpitations. I'm trying to bill 99395, 9921(4)-25, and 93000. Is this correct? A scrubber I am using states you cannot bill 99214 with 93000 per CPT coding concepts. I know we bill this fairly often, so I'm not sure if the scrubber is inaccurate or I am doing something wrong. does it need an additional modifier somewhere?

Any help is appreciated!

Lindsay Bockis, CPC-A
Albany, NY

 

[Orthocoderpgu]

My scrubber allows but..

My scrubber allows all three codes without hitting an edit.

Some insurance companies will bundle small diagnostic tests into the higher code levels (99214, 99214). So we could not bill out 99214 and a UA because the insurance would state that the UA was bundled into the 99214.

I would see no issues billing 93000.

However I would question billing 99395 & 99214 together. Remember, anything performed for 99395 cannot be used in the calculations for 99214. I think this is going to be more of an issue for you. 99214 requires a detailed history, detailed exam and moderate MDM. And 99395 is for a "Comprehensive" examination. Almost all of your examination has been used in 99214, or 99395. You can't have a comprehensive exam for 99395 and a detailed exam for 99214.

If the 99214 is for the heart issue, I would consider billing 99213 or maybe even 99212. This will depend on if the palpitations were diagnosed during this exam or if this is a known medical condition when the patient came in.

 

[bnockis]

Thank you so much! I will review the chart note and see which office visit may be more appropriate.

 

[bnockis]

Any advice on which modifiers would be correct and on which service(s)?

 

[bnockis]

Also, the new complaint is for hip pain, which they recommended referring to an ortho.