Wiki Re: 93010

[cynthiaj54]

Re: 93010

Does anyone have a expert 2008 CPT book? We had a payer tell us we have to use a 26 modifier on 93010 for the EKG interp. I tried to explain to her that this was the physicians portion and no modifier is needed. Am I wrong??
She said her 2008 expert CPT book had a box that says modifer is necessary. I only have the professional.
Thanks for any input.

 

[LLovett]

Your not wrong

I don't have an expert book but that is either a misprint or she doesn't know how to read the book.

When I added the code with the modifier to my claim scrubber this is the response I got.

Modifier -26 is not appropriate with Procedure Code 93010 because that procedure is either defined as 100% technical, 100% professional, or does not have a professional/technical split.

Good luck fighting that one out,

Laura, CPC

 

[DGRAF]

I bill the 93010 all the time to numerous payers and have never run into that. It is only for the professional portion and therefore the modifier would be redundent. Sorry I also have the professional CPT manual, but there must have been a print error in the expert.

 

[FTessaBartels]

2008 Expert CPT

The 2008 Expert CPT does indead have a little box next to 93010 with 26 in it.

BUT if the payer had read the introduction to CPT expert edition she'd know that the little box means: Only codes with this icon represent the physician's work or professional component of a procedure or service. Do not use either modifier 26 (physician component) or TC (technical component) with these codes. (emphasis added by FTB) This guideline is on page i of the Introduction section of 2008 CPT Expert edition published by Ingenix.

F Tessa Bartels, CPC, CEMC