Wiki Lines on Annual Physical not paying

[jmeberst314@gmail.com]

Is anyone else having issues with EKG's (93000) and/or UA's (81003) not paying during annual physical's (99395-99397)? We've been using V70.0 as the dx but were told today by UHC that the procedure codes are general medical, not preventative. Are there preventative EKG's and UA's that we should be using?

 

[britbrit852003]

When we bill EKGs and UAs at the time of a physical we do not use V70.0 as their diagnosis we use:
81003-V81.5
93000-V81.2
These diagnoses seem to get them paid.

 

[KSanders1983]

That is odd that it will not pay for 81003 with v70.0. We have found that "routinely" people do not have EKGs unless there is a family history.
So, v70.0 would not be valid for an EKG..if family history I would use
v12.5-v12.59. EKGs would be paid for if pre-op but it would not be v70.0 then either.

I hope this helps!

 

[abctibbett@gmail.com]

v70.0

81000 and 81001 are billable preventative benefits with the V70.0 diagnosis for BCBS PPACA plans. I run into this a lot of times where our providers want to do a different type of screening that doesn't fall into the fully-insured preventative categories. You may have to talk to your docs to see why that test is necessary, when another similar test would be covered at 100%. Then advise the patient that not all of their 'preventative' visit is covered.

 

[dclark7]

Only procedures that are graded A or B by the Us Preventative Task Force (USPSTF) are covered as screenings or for preventative medicine. ECG and urinalysis are both graded D therefore they are not recommended as screening tests. You can find information on the USPTF website http://www.uspreventiveservicestaskforce.org/index.html

Many insurance companies did cover these test prior to the ACA, now they are only covering what is on the USPST list.