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Wiki Is this proper coding

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calexander

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I visited an office recently and was observing the coding procedures. I am unsure of one procedure. What do you think?

93000 is for an ekg. Global charge. It is done in the office with the offices equipment, with the office employee.
For some reason Medicare is dening it. ( I did not review the EOB)
Anyways,
They are billing it this way
93010-26 professional component
93005-tc technical component
Medicare is paying this way. Instead of finding out why the global is not being paid they are billing the 2 seperate components.

Should this be billed this way? Is there a rule stating this is unbundling or unethical?

Thanks,
calexander :rolleyes:
 
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We had a group of physicians a few years ago start having all of there EKG's and x-rays denied by Medicare. We didn't realize that their zip code fell into the PSA's (Physician Scarcity Area) and once we knew that we had to start splitting out any service that had a professional and technical component. So my guess would be that this provider is in a PSA or an HPSA.
 
If they are in a PSA then this would be the correct way to bill for there EKG's otherwise they should bill just the 93000.
 
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