Wiki Medicare Reimbursement for EKG's

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uncapooh

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HI ALL...I NEED SOME HELP HERE. I AM A NEW BILLER/CODER AND I'M HAVING TROUBLE GETTING REIMBURSED FOR EKG'S DONE IN DOC'S OFFICE.

IS THERE A V CODE OR SPECIAL MODIFIER THAT I NEED TO SUBMIT WITH CODE 93000? ANY AND ALL HELP WOULD BE GREATLY APPRECIATED:confused:
 
What is the denial reason? If you have a covered diagnosis and have box 17 and 17b filed in then there really shouldn't be any problems!
 
Hello:

The V72.81 - Pre-operative cardiovascular examination can be used for a pre-op EKG in the absence of a sign or symptom.

Check with your Medicare carrier to see if they have a policy on EKG to ensure you are coding and listing your diagnoses correctly on the claim form.
 
In PA we have to code the 93000 for Medicare patients as 93005 and 93010. I don't know why they want it seperated out, but we do and we get paid for them. You do not have to use the TC and 26 modifiers with these codes.
 
Medicare EKG

For EKGs (in Washington) there is a LCD to for EKGs. There must be a specific dx or symptom as to why the EGK is being done considered medically necessary from the LCD for reimbursement. Pre-op EKGs are never paid for if that is the only reason it is being done.
 
In CT there is an LCD for EKG's. You can go to your carriers website and look up the LCD, it will give you the covered diagnoses. V72.81 was a covered dx until 8/08 now it is not covered. Like any procedure there must be a medically necessary reason to do the EKG. If you're having trouble with another carrier, try their website. Most carriers have sections that list what procedures are covered and the rationale.
 
Ekg and medicare

Thank you all so much for your replies!!!! You gave me some good options to check out.:d
 
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