Wiki Medicare Advantage Plan (Humana)

[mbarbour]

Humana has been denying our Electrocardiogram, routine ECG with at least 12-leads; interpretation and report only; 93010. Our ER physicians bill this procedure code and Humana has been denying them stating the procedure code is incorrect/or invalid. Of course, I have call Humana and they only say I need to send in the ER notes. Then I found out from coding/editing at Humana that they feel as if the ER physicians abuse this CPT code this is why they want the ER notes. Does anyone know where I can locate the Medicare guidelines for this CPT code? Medicare does pay for this procedure. Or if anyone knows where I can find Humana's policy about this CPT code it would be greatly appreciated.

 

[lavanyamohan]

Hi,

Please find below the following coding piece of information:

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit.

Regards,
Lavanya Mohan

 

[jwolf13721]

Lavanya,

Can you share with us the source of your response or a link the where you obtained this information?

Thank you,

Jacqueline F. Zollman, CPC

Hi,

Please find below the following coding piece of information:

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit.

Regards,
Lavanya Mohan