Question EKG Bundled into Programming/Interrogation device evaluation

Shay0287

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Hackensack, New Jersey
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Hello, one of my providers is trying to bill for an Office Visit, EKG, and Pacemaker Check on the same date of service. There is a CCI edit for the Pacemaker check and EKG and was told by another Cardiology Coder at an AAPC conference to just put a modifier 59 on the EKG. I even mentioned that if a CCI edit exists that maybe both shouldn't be billed on the same DOS unless the documentation shows the medical necessity for the EKG but the Coder stated that the medical necessity should be the same for why the patient has a pacemaker. Since most of these patients are Medicare, I feel uncomfortable just adding modifier 59 to bypass the CCI edit and receive reimbursement as the overutilization of the modifier 59 will put my organization at risk for audits. Are other cardiologist receiving payment without an issue for both device check and EKG on the same DOS? Are there any recommendations on the documentation that will support the reporting of modifier 59?
 

kjbeams

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Springfield, IL
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If the EKG was done at a different time on the same day you can bill for it...but not as part of the PM check. We add the modifier XE to the EKG and add the time it was done in the additional info line.
If it's just part of the PM check...we don't bill for it. But if you are using it as a diagnostic tool...that determines your medical necessity.
 

ED752

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Hello,

Can I ask which code you are using for the pacemaker check? Our practice crosses the EKG off automatically if there was a device check done on the same day. I’m wondering if we should try using modifier XE since they’re done separately and not part of the device check. Thank you.
 
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I believe the Pacemaker interrogation does not report the QRS waves which are needed by the electrophysiologist to determine if the patient has a heart block, LBBB or other issues. This is the necessity for the EKG on the same day as a pacemaker interrogation. However, remember the physicians documentation needs to be documented for the medical necessity of the EKG. Use modifier 59 on the EKG.
 

fwnewbie

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New Haven, IN
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PM interrogation shows how the heart muscle is responding to a particular voltage in a particular spot of the heart. It is set to the minimum heart rate that will cause the pacer to fire(sensing) and the heart to respond to the current (capture), battery info, and rhythm but I don't think it will show a rhythm strip which is found on an EKG.
It still says under the EKG section that you need a specific order for the EKG.
 
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