-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
office visit and EKG to Medicare
- Thread starter gsharma
- Start date
chenson384
Contributor
ekg
We are paid by Medicare when we bill E&M and EKG with no modifier, but we do put the ordering physicians name on the claim(referring provider on our software). Also, the diagnosis must meet medical necessity. For example, Medicare will not pay for an EKG for pre-op clearance.
We are paid by Medicare when we bill E&M and EKG with no modifier, but we do put the ordering physicians name on the claim(referring provider on our software). Also, the diagnosis must meet medical necessity. For example, Medicare will not pay for an EKG for pre-op clearance.
amar1727
Contributor
Medicare is denying our EKG that was done with an office visit. Is ther a specific modifier that should be added to the EKG? I've worked OB/GYN for years new to Family Practice. thanks
What is the reason for the denial ? The Ekg should be sent in with a modifier 25, but also make sure that the diagnoses code is consistant with the procedure.
jackson7591
Guest
reason for ekg?
CMS chapter 12 section 30.6.2 addresses EKGs during a preventative medicine services stating
"procedures which are for screening for asymptomatic conditions are considered noncovered and therefore, no payment is made. Those procedures ordered to diagnose or monitor a symptom, medical condition or treatment are evaluated for medical necessity and, if covered, are paid."
http://www.cms.gov/manuals/downloads/clm104c12.pdf
Section also addresses furnishing a covered vist at the same place and on the same occasion as a noncovered preventative medicine service.
Does the documentation demonstrate the medical necessity of obtaining an EKG?
CMS chapter 12 section 30.6.2 addresses EKGs during a preventative medicine services stating
"procedures which are for screening for asymptomatic conditions are considered noncovered and therefore, no payment is made. Those procedures ordered to diagnose or monitor a symptom, medical condition or treatment are evaluated for medical necessity and, if covered, are paid."
http://www.cms.gov/manuals/downloads/clm104c12.pdf
Section also addresses furnishing a covered vist at the same place and on the same occasion as a noncovered preventative medicine service.
Does the documentation demonstrate the medical necessity of obtaining an EKG?
Last edited:
brookeborne
New
Ekg denials
We are a cardiac practice, we bill an E/M with modifier 25 and diagnostic EKG. The referring provider is our cardiologist. Claim is denied "referring provider is not eligible to refer these services:. We changed the referring provider to the PCP that sent the patient to our practice. Claim again denied for the same reason. Any suggestions. I thought you did not need a referring provider when the service was performed in your office.
We are a cardiac practice, we bill an E/M with modifier 25 and diagnostic EKG. The referring provider is our cardiologist. Claim is denied "referring provider is not eligible to refer these services:. We changed the referring provider to the PCP that sent the patient to our practice. Claim again denied for the same reason. Any suggestions. I thought you did not need a referring provider when the service was performed in your office.
mitchellde
True Blue
We are a cardiac practice, we bill an E/M with modifier 25 and diagnostic EKG. The referring provider is our cardiologist. Claim is denied "referring provider is not eligible to refer these services:. We changed the referring provider to the PCP that sent the patient to our practice. Claim again denied for the same reason. Any suggestions. I thought you did not need a referring provider when the service was performed in your office.
Perhaps it is the qualifier you are using or lack of qualifier in field 17. And yes the referring physician field (17) needs to be populated even if performed in your office. That is why they created the qualifiers.