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Patricia L Diaz

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Need some help, our Dr.(FP) did a ov, ekg and earwash all in one day in the office...it was submitted as

OV-proc 99213/25 DX 7804
Earwash proc -69210 dx 3804
EKG proc 93000 dx 7804

this came back with ov pd and earwash paid but the EKG was not paid...so...the insurance person refiled the EKG as proc 93000/25 and this too came back denied due to modifier...

How should this have been submitted so the Dr can get pd for all??? Modifier 51???

Any feedback will be appreciated!!!
 
Patricia L Diaz said:
Need some help, our Dr.(FP) did a ov, ekg and earwash all in one day in the office...it was submitted as

OV-proc 99213/25 DX 7804
Earwash proc -69210 dx 3804
EKG proc 93000 dx 7804

this came back with ov pd and earwash paid but the EKG was not paid...so...the insurance person refiled the EKG as proc 93000/25 and this too came back denied due to modifier...

How should this have been submitted so the Dr can get pd for all??? Modifier 51???

Any feedback will be appreciated!!!
Click to expand...

First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure.
Second the 25 is used only on the E&M code
third what was the denial reason for the EKG on the initial submission?
 
mitchellde said:
First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure.
Second the 25 is used only on the E&M code
third what was the denial reason for the EKG on the initial submission?
Click to expand...
sorry...I did not use the proper definition..."First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure." I too agree with this, the EKG was denied on the initial submission due to..

#1 -"Submission/billing error (s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code)" (code 125 on EOB)

#2 (code M15 on EOB) "Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

Any comments/advice?
 
WE recently submitted an office visit with mod 25, 69210 done by the physician and documented, and EKG. It was stopped byour clearing house because:" the combination of 69210 and 93000 violate the NCCI policy for component codes".

My ? is shouldn't the modifier 25 cover this?
Thanks for any input
 
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