EKG + ETT Same Day

[amym]

Help! Humana is denying all of our EKGs, 93000, when done same day as ETT, 93015. Patient comes in for an evaluation lets say for dizziness and we perform an EKG, the EKG is abnormal and the patient is then scheduled for ETT, in our office, same day. We have appealed to the highest level possible but they are stating our notes do not support the need for EKG and ETT same day. I am providing a copy of the progress notes, can someone please help and let me know if this is being denied correctly. What are we doing wrong? Thanks in advance.

Reason for Appointment
1. 4 WK F/U
2. Dizziness,Fatigue

History of Present Illness
Cardiology:
1. Hx of AWMI
2. Hx of PCI
3.LV dysfunction
Echo Jan 2012 with EF 35-40%
4. DM-II - followed by Dr.
5. HTN
6. HLP.
Pt is here for f/u - Sx have been the same, he does note additionally that he has been noticing some dizziness. By description somewhat orthostatic. Labs from Dr. 's office reviewed. HDL is low. TG is borderline elevated.
Echocardiogram:
01-31-12 Normal LV size with EF 35-40% Mild RWMA in LAD distribution. Mild LAE. Mild AI. Decreased LV compliance.
Lexiscan Myoview:
02-28-12 Large anterior, apical and inferior scar without ischemia. EF is 41%.
Labs:
01-12 HDL 33, TG 103, LDL < 80, A1C 6.0.

Vital Signs
Wt 179, BP 126/72, SO2 98, HR 82, Notes NP, Ht 66, BMI 28.89.

Examination
Exam:
General appearance: pleasant, NAD, well-developed, well-nourished. HEENT: unremarkable, no xanthelasma. Neck: supple, nontender, no thyromegaly. Carotids: normal, no bruit, upstrokes intact. JVD: normal, no hepatojugular reflux. Chest: nontender,no pectus deformity. Heart sounds: regular, nomal S1, S2, no S3, or S4, 2/6 systolic murmur. Lungs: clear to auscultation, no rales, wheezes or rhonchi. Abdomen: soft, no hepatomegaly, no masses palpated, non-tender, no bruits, bowel sounds present. Extremities: no leg edema, no cyanosis or clubbing. Peripheral pulses: intact, 2 + bilaterally. Neurologic: alert and oriented x 3, grossly intact. Mood: normal. Lymphatic: no gross cervical lymphadenopathy. Back: nontender, no kyphoscoliosis. Skin normal turgor, no rash or ulceration.


Assessments
1. CAD-Coronary atherosclero of native vessel - 414.01 (Primary)
2. HDL [high-density-lipoid] deficiency - 272.5
3. Left ventricular systolic dysfunction - 428.1
4. Dizziness - 780.4
5. Fatigue and malaise NOS - 780.79

Treatment
1. CAD-Coronary atherosclero of native vessel
Known MI with a fixed defect on TST. No ischemia. Will need aggressive risk factor modfication.

2. HDL [high-density-lipoid] deficiency
Start LOVAZA TABLET, 1000MG, 1 TAB, PO, BID, 30, 60

3. Left ventricular systolic dysfunction
Start Coreg tablet, 3.125 mg, 1 tab(s), orally, 2 times a day, 30 day(s), 60, Refills 3
Pt with Low ef but borderline for AICD criteria - discussed and educated. Currently unsure, wishes to wait and be reassessed.

4. Dizziness
Diagnostic Imaging:EKG
Suspect orthostatic - conservative measures discussed, if worsens, may need to decrease medication. Will need to start Coreg given LV dysfunction - may worsen dizziness - discussed with pt and educated. Will obtain EKG.


Procedures
Lexiscan Cardiolyte:
Perfusion results 02-28-12 Large anterior, apical and inferior scar without ischemia. EF is 41%..


Procedure Codes
93000 EKG Complete

Follow Up
3 Months

 

[washington-hunt]

ekg w/ ett

ekg cpt code 93000 with lexiscan stress test cpt code 93015= in office

per cci edits , the following services are included in the stress test:93015-93018
electrocardiogram (93000-93010) and rhythm strip (93040-93042)
pulse oximetry (94760-94761)
injection or infusion (e.g., 90774)

Seperate charges should not be subimtted for the services

 

[amym]

I was advised by a coder if we peform an EKG when the patient presents to the office and EKG is abnormal and results in performing an ETT that we can bill it with a -59 modifier. The EKG is done seperately with different leads and is not the baseline from the ETT. Other payers are paying just fine. We are only having issues with Humana.

 

[strader]

I agree you should be able to bill 93000-59 to bill for an EKG the same day as an ETT is performed. I have had situations with Humana with McKesson edits conflicting with CCI edits when a modifier should apply. Sorry, I don't have access to McKesson edit right now, but the Customer Service Rep should be able to tell you how to access that to find the correct modifier and/or the McKesson rationale for denial. They are usually just wrong, but they do have a little bit of a reason for their edits (ie they deny Echo readings when performed the same day as an inpatient E/M code because they think the cardiologist discusses the Echo with the patient the same day. However, that does not account for the cardiologist going to a separate location to view the echo and dictating a completely separate technical interpretation and report for the medical record, totally aside from what he is able to talk to the patient/family later in the day or some days later)