G0403(Medicare EKG)

akaeb

Networker
Messages
33
Best answers
0
I do the coding and billing for a Rural Health Clinic and one of the providers is billing a G0402(Initial preventative physical exam-face to face visit) as well as G0403(EKG performed as a screening for the initial preventative physical exam with interpretation and report) but medicare is denying the G0403 saying that the code is invalid even though it is in our HCPC book. We have called medicare and they are basically telling us the same thing. Has anyone else had this problem?

Thank you!
 

Cole1971

Contributor
Local Chapter Officer
Messages
15
Location
Toledo, OH
Best answers
0
G0403 help

This is confusing to me also, Did your office do the ECG? I'm thinking the G0403 can be billed by the provider actually doing the screening??
Did you bill (attach it to Z00.00)
"Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report"

Any other help would be greatly appreciated!
 

slabrec89

New
Messages
2
Best answers
0
When billing the G0402 & G0403 together for the same DOS is there a modifier needed to ensure accurate processing of claim without denial?
 

Ardith

New
Local Chapter Officer
Messages
7
Location
Yakima, WA
Best answers
0
Yes, you will need a modifier when reporting codes G0402 & G0403 together. While there is no CCI edit in place for the code pair, Medicare Claims Processing Manual instructions state that modifier 25 should be appended to an evaluation & management visit when performed with another significant procedure. In this instance, the G0402 would be considered the E&M.

G0403 is the global service, so the provider would need to have completed the ECG test and then provided the interpretation and report. If another place provided the ECG, they would submit G0404. The physician providing the interpretation & report would submit G0405.

For FQHC/RHC claims requirements, guidance is found within Publication 100-04 Medicare Claims Processing Manual, Chapter 9, Subsection 70.6 Initial Preventive Physical Examination (IPPE). I've copied & pasted the instructions below because there are some particular nuances for your scenario, e.g. the professional component is part of the AIR reimbursement. Due to this, you may need to submit G0404 on the claim.

70.6 - Initial Preventive Physical Examination (IPPE)
(Rev. 3434, Issued: 12-31-15, Effective: 03-31-16, Implementation: 03-31-16)

"FQHCs and RHCs billing under the AIR system Medicare provides for coverage for one IPPE for new beneficiaries only, subject to certain eligibility and other limitations.

Payment for the professional services will be made under the AIR. However, RHCs/FQHCs can receive a separate payment for an encounter in addition to the payment for the IPPE when they are performed on the same day.

When IPPE is provided in an RHC or FQHC, the professional portion of the service is billed on TOBs 71X and 77X, respectively, and the appropriate site of service revenue code in the 052X revenue code series, and must include HCPCS code G0402. Additional information on IPPE can be found in Chapter 18, section 80 of Pub. 100-04.

EKGs

The professional component is included in the AIR or FQHC PPS and is not separately billable.

The technical component of an EKG performed at a RHC/FQHC billed to Medicare on professional claims (Form CMS-1500 or 837P) under the practitioner’s ID following instructions for submitting practitioner claims for independent/freestanding clinics. Practitioners at provider-based clinics bill the applicable TOB to the A/B MAC using the base provider’s ID.

FQHCs billing under the PPS:

IPPE is qualifying visits when billed under G0468, for additional information on the payment specific codes and qualifying visits, please refer to section 60.2 of this manual. Under the FQHC PPS, IPPE does not qualify for a separate payment when billed on the same day with another encounter/visit."
 

twalls

Contributor
Messages
15
Best answers
0
A bit off topic but besides the IPPE visit, when it is necessary to spit the ECG for Medicare patients using 93005 & 93010- when the provider is doing the order, report, and interpretation? Wouldn't you just use 93000?

You're input is certainly appreciated!

Thank you!
 
Top