Wiki Procedure Code 93010

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mbarbour

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I work for Emergency Room physicians and we bill procedure code 93010. We are having problems with the Humana Medicare Advantage Plan paying for these. Is anyone else having this issue? Our Emergency Room physicians do not work for the hospital but bill separately for their services.
 
Humana Denials

1st one states that the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.(ED visit-only other procedure) 2nd use of modifier on this service or a related service, billed on the same date by the same provider is not supported by the information on the claim or in member history.(we did use a -59 in one case)
 
Depending on the diagnosis and documentation, many payers feel the EKG is a part of the E&M and not separately billable. The rationale is that if your patient presents with say chest pain then the EKG is a necessary part of the examination process and included under MDM.
 
Also, in most hospital settings, all EKGs are officially read by a Cardiologist who bills for this component of the EKG, just as a Radiologist reads and bills for the professional component of imaging services in the hospital. Probably, this is where the first denial is coming from, the reading Cardiologist has already billed and been paid for the service. The E/R physician's reading of the EKG is considered integral to the E/M service, as Debra noted.
Karen Hill, CPC, CPB, CPMA, CMBS
 
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