Wiki EKG Denials

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Watkins.Jess

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I need help with an error from denials when billing for EKG's. We have been getting a lot of EKG's from denials stating, "This service/procedure requires that a qualifying service/procedure be received and covered."

Does anyone know what they mean by a qualifying service/procedure?
 
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Hi Watkins-Jess:)
I believe qualifying service means when doctor does a EKG then he or she interprets EKG readings then add that code too. So for EKG CPT then add CPT 93227 hopeful done same day as EKG taken. Read CPT 93224-93227 to match properly documentation. Ensure the dx code matches of R00, R07, I51.9 or I48 is first if documentation matches or whatever sign or symptoms matches patient dilemma. Use the Z code Z13.6 as 2nd dx or Z01.89 or Z01.81 as first dx if necessary.
I hope helped you
Lady T:geek:
 
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TThivierge said:
Hi Watkins-Jess:)
I believe qualifying service means when doctor does a EKG then he or she interprets EKG readings then add that code too. So for EKG CPT then add CPT 93227 hopeful done same day as EKG taken. Read CPT 93224-93227 to match properly documentation. Ensure the dx code matches of R00, R07, I51.9 or I48 is first if documentation matches or whatever sign or symptoms matches patient dilemma. Use the Z code Z13.6 as 2nd dx or Z01.89 or Z01.81 as first dx if necessary.
I hope helped you
Lady T:geek:
Click to expand...
93227 is the code for a continuous 24-hour ekg (up to 48 hours).

ALSO, the dx used should be the reason the provider ordered the test. we can't code bassed on a list of covered dx.

Watkins.Jess said:
I need help with an error from denials when billing for EKG's. We have been getting a lot of EKG's from denials stating, "This service/procedure requires that a qualifying service/procedure be received and covered."

Does anyone know what they mean by a qualifying service/procedure?
Click to expand...
I think your question was about the denial reason. I don't have that answer.

what CPT and Dx were billed (that might help us give some insight)?
 
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lgardner said:
93227 is the code for a continuous 24-hour ekg (up to 48 hours).

ALSO, the dx used should be the reason the provider ordered the test. we can't code bassed on a list of covered dx.


I think your question was about the denial reason. I don't have that answer.

what CPT and Dx were billed (that might help us give some insight)?
Click to expand...
Hi Lgardner:)
I did say the dx coded selected should be matched to the patient's dilemma which would be documented by the provider as the medical necessity of the reason for the EKG. All professional coders know you have to code according to the provider' s assessment. You are right the questioner above should have given us a bit more data
Lady T;)
 
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Thank you everyone!

So, I found out that the person that has been billing these the past 7 years did NOT bill the EKG's done in the ER. We have outsourced the EKG's to a company and they are billing the ER EKG's. There is a dilemma about whether or not the EKG's are even billable. The cpt code is 93010 and the dx codes are usually passing ones (if not we find a passing dx from documentation). I have been looking back on these denied claims and there is no E/M billed for that DOS. Could this be causing the error?

In the mean time, we are waiting to hear from Blue and Co about whether or not these should even be billed. Sorry about the confusion!
 
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Hi Jess.Watkins, I have been billing CPT 93010 for the past 5 years and we get paid. However my doctors read it at POS 22 or 21. And in my experience 93010 gets paid with a Dx related to cardio or arrhythmia. Hope this helps. Thanks
 
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Watkins.Jess said:
Thank you everyone!

So, I found out that the person that has been billing these the past 7 years did NOT bill the EKG's done in the ER. We have outsourced the EKG's to a company and they are billing the ER EKG's. There is a dilemma about whether or not the EKG's are even billable. The cpt code is 93010 and the dx codes are usually passing ones (if not we find a passing dx from documentation). I have been looking back on these denied claims and there is no E/M billed for that DOS. Could this be causing the error?

In the mean time, we are waiting to hear from Blue and Co about whether or not these should even be billed. Sorry about the confusion!
Click to expand...
I don't code cardio, but I recall learning that most insurances will only pay for ONE clinician to read the EKG. Your physicians may be able to count it toward MDM, but if the ER physician already billed for the read, you will likely not also be paid for the read.
 
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