Wiki IPPE and EKG

[kbarron]

We are getting denied for G0403. My understanding is that if there is medical necessity, the EKG needs to be referred as a result of the IPPE. Who do we refer to? Don't you need to have medical necessity for an EKG? Screening is wrong terminology in my opinion as screening EKG on NH LCD is non covered. I may be over complicating this.

 

[btadlock1]

We are getting denied for G0403. My understanding is that if there is medical necessity, the EKG needs to be referred as a result of the IPPE. Who do we refer to? Don't you need to have medical necessity for an EKG? Screening is wrong terminology in my opinion as screening EKG on NH LCD is non covered. I may be over complicating this.

I'm not 100% sure what you're asking, but -
A routine EKG is included in the IPPE, but if there's medical necessity to perform an EKG (problem diagnosis), bill a 93000 with a 59 modifier, and your problem Dx, and it should pay. Hope that helps!

 

[kbarron]

NHIC is telling us that " procedure not billable to fiscal intermediary" and we are using G0403. We are a CAH method II in New Hampshire.

 

[kbarron]

any more takers on this?

 

[Lancia1]

IPPE and EKGs G0404-5

We are billing G0402 and, when indicated, G0403-G0405, with code V70.0. We are being paid for G0402 and G0403, but have not been paid on any patient for G0404-05. The denial is "Claim lacks information....use remark codes." Should we change the diagnosis code??? or add a modifier to G0402??? Anybody have any experience with this?

Thanks,
Louise Cook, CPC
Atlanta, Georgia

 

[ajs]

We are billing G0402 and, when indicated, G0403-G0405, with code V70.0. We are being paid for G0402 and G0403, but have not been paid on any patient for G0404-05. The denial is "Claim lacks information....use remark codes." Should we change the diagnosis code??? or add a modifier to G0402??? Anybody have any experience with this?

Thanks,
Louise Cook, CPC
Atlanta, Georgia

I would contact your local Medicare carrier to ask why the other EKG codes are not being reimbursed. As long as the provider is only doing a tracing, or only doing the interpretation and report, those codes are acceptable. But if any other provider is billing the global code G0403, they will deny the other two codes.