Office visit with EKG?

cnramsey

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Priest River , ID
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Since we own the EKG machine we will bill a 93000 for our commercial insurances. The 93000 is billed when all elements are meet to bill for the interpretation and report. That being said if my presenting problems meet a 99214 and the provider also orders an ECHO, Holter Monitor and the EKG I'm billing the interp and read for will this support 99214 under complexity of Data? Any combination of 3 from the following: Ordering of each unique test? I wouldn't be double counting the EKG right? Since I'm only billing for the read not the order of the EKG??
Any input would be greatly appreciated.

Thanks,
Nichole
 

csperoni

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Selden
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You cannot count ordering for a test you are performing, unless the test does not have any interpretation (ie rapid strep). The theory is the work of ordering is built into the value of 93000 and you are being paid for the ordering that way.
If the echo & holter are not being billed by you, you may count those 2 data points, which brings you to limited data (level 3).
You might still meet a 99214 overall if your risk is moderate or high.
 

cnramsey

Networker
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Priest River , ID
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You cannot count ordering for a test you are performing, unless the test does not have any interpretation (ie rapid strep). The theory is the work of ordering is built into the value of 93000 and you are being paid for the ordering that way.
If the echo & holter are not being billed by you, you may count those 2 data points, which brings you to limited data (level 3).
You might still meet a 99214 overall if your risk is moderate or high.
Thanks for responding to my questions. I agree with what you have said but I can’t get someone else to understand. Hopefully more coders and auditors will respond and I can use this as an educational tool.
 

csperoni

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Just show them the AMA 2021 guidelines.
Specifically:
The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level.
 

cnramsey

Networker
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Priest River , ID
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Just show them the AMA 2021 guidelines.
Specifically:
The ordering and actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the levels of E/M services when the professional interpretation of those tests/studies is reported separately by the physician or other qualified health care professional reporting the E/M service. Tests that do not require separate interpretation (eg, tests that are results only) and are analyzed as part of MDM do not count as an independent interpretation, but may be counted as ordered or reviewed for selecting an MDM level.
I discussed the guidelines yesterday with the individual. This morning I emailed all providers the AMA 2021 guidelines again. I've sent it to them before but that was months ago so a little reminder can't hurt. Yesterday this is what was sent back to me after our phone discussion regarding not being able to count the EKG towards ordered or reviewed since we would be billing 93000 for the EKG interpretation. "Discussed on the phone-separate the ordering of the EKG from the interpretation and billing, they are two different cognitive tasks". They truly believe they are not doing anything wrong and I'm trying to lightly show them it's not correct.

Thanks again for sending me this link above. I had it saved on my desktop but I don't believe I had sent this particular AMA one to the clinic providers.
 

csperoni

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I believe what the provider is misunderstanding is not whether the ordering and interpretation are two different cognitive tasks. No one is saying there is not work and/or a cognitive task involved in ordering the EKG.
It is simply a matter of how/where you receive credit for those two different tasks of ordering and interpreting. The value of 93000 has built into it wRVU of .17. That .17 covers the work of ordering the test. They are being paid for ordering, just under 93000. Since you are being paid for the work of ordering under 93000, you cannot count that same work again for E/M.
The provider may not agree. The provider may not like it. The provider may not think it's fair. However, this is the current guideline.
Also remember if they feel this change is punitive, there were other changes that were beneficial. For example: counting EACH lab/test.
 

cnramsey

Networker
Messages
43
Location
Priest River , ID
Best answers
0
I discussed the guidelines yesterday with the individual. This morning I emailed all providers the AMA 2021 guidelines again. I've sent it to them before but that was months ago so a little reminder can't hurt. Yesterday this is what was sent back to me after our phone discussion regarding not being able to count the EKG towards ordered or reviewed since we would be billing 93000 for the EKG interpretation. "Discussed on the phone-separate the ordering of the EKG from the interpretation and billing, they are two different cognitive tasks". They truly believe they are not doing anything wrong and I'm trying to lightly show them it's not correct.

Thanks again for sending me this link above. I had it saved on my desktop but I don't believe I had sent this particular AMA one to the clinic providers.
After sending the AMA link...they now see what I was saying and agree with my audit. Thanks again!
 
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