Good afternoon everyone!
We work at a local hospital and have been receiving A LOT of EKG 93010 denials bundling with both E/M inpatient and outpatient codes--these denials are mostly from BCBS HMO and BCBS PPO.
Btw, these EKG's were billed separately on the same service dates as the E/M codes; not during the same encounter. Therefore, some of these E/M codes were billed by different providers of the same specialty and providers of different specialties.
I've spent several hours online researching for EKG bundling coding guidelines including CMS.gov, but have been unsuccessful unfortunately. I'm unable to find NCCI/CCI modifier indicator edits for 93010 with outpatient/inpatient E/M codes
The only online guidelines found were EKG's billed with critical care, but even those online sources were conflicting. A few online sources stated 93010 and critical care can be billed separately, but there were other online sources stating that 93010 is bundled with critical care.
Modifier -25 were appended to these E/M codes but 93010 still denied as bundled services.
We need to know whether or not to append modifier -59 to 93010's or if these bundling denials correct?
Can someone knowledgeable of this information provide the appropriate guidelines from a reputable online source?
Thank you in advance for your assistance!
We work at a local hospital and have been receiving A LOT of EKG 93010 denials bundling with both E/M inpatient and outpatient codes--these denials are mostly from BCBS HMO and BCBS PPO.
Btw, these EKG's were billed separately on the same service dates as the E/M codes; not during the same encounter. Therefore, some of these E/M codes were billed by different providers of the same specialty and providers of different specialties.
I've spent several hours online researching for EKG bundling coding guidelines including CMS.gov, but have been unsuccessful unfortunately. I'm unable to find NCCI/CCI modifier indicator edits for 93010 with outpatient/inpatient E/M codes
The only online guidelines found were EKG's billed with critical care, but even those online sources were conflicting. A few online sources stated 93010 and critical care can be billed separately, but there were other online sources stating that 93010 is bundled with critical care.
Modifier -25 were appended to these E/M codes but 93010 still denied as bundled services.
We need to know whether or not to append modifier -59 to 93010's or if these bundling denials correct?
Can someone knowledgeable of this information provide the appropriate guidelines from a reputable online source?
Thank you in advance for your assistance!
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... it was disappointing after all of the researching involved, downloading and searching those spreadsheet files, I was only able to find one NCCI edit for 93010 and 99211.