Wiki mod.59 for EKG 93000 and ov 99213-25

[benaxixon]

Hi,
I'm now questioning myself if I over used mod. 59 for this. I have Medicare paid OV. with mod. 25 and dx: V72.84 but denied EKG 93000 DX: v72.84 as BUNDLED. I reviewed the Medicare LCD and CCI Edit stated a modifier can be added to show the separation. I rebilled to Medicare with mod. 59 on the EKG and Medicare did allowed for it. But now I'm wondering if I over udes the mod. 59 and EKG is bundled with the OV. Please advise. Thank you.

 

[Teresa Collins]

I use ICD-9 V72.81 for the 93000 in this type of situation (which is covered in the LCDs on Trailblazer's web site) and is reimbursed by Medicare. I would also append modifier 25 with the E/M just as you did.

Hope this helps!