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Repeat EKG- tech. error

Sarah Ann

Sarah Ann

Networker
Messages
73
Location
Concord, NH
I've come across charges for a repeat ekg- It was repeated because they didn't place all of the leads.
2 ekg's are entered- I don't think both of these should be charged even with a modifier. Am I correct?
 
IMO you should not bill for both EKGs if the repeat procedure was done due to technician error. Neither the insurance company nor the patient should be financially liable for a service that was only rendered due to the technician's error. How would you feel if you were the patient and were expected to pay for a 2nd EKG that only had to be performed due to the error?
 
As a coder I am ethically obliged not to code for two ekg when there is only one order. However, it has been pointed out by the department supervisor that "when you see two EKG in the chart please code for two ekg". Of course, there is no medical necessity for the second; neither is there a reason why there are two tracing in the chart. Tthe justification is that each reflects a different time and therefore they are acceptable. For me coding guidelines, medical necessity and ethical practices cannot be upheld in a revenue driven environment.
 
Hi Sarah,
You are correct. But also if 2 claims sent the coder may have to view the results then put a claim note to tell why it should not be billed. Also when it is sent to the payer; they may reject it or ask for medical records to support the 2 EKG services billed. Also maybe your department supervisor, her superior has been told to bill 2 CPT same thing despite discrepancies to show errors made by EKG techs. Later EMR and or fiscal reports would show this if a denial mode due to errors made in the EKG department. Management may have told the supervisor to do this but she should explain to you better. They should let you put a comment on claim explaining the error of EKG lead problem so once it gets in the billing bucket to the payer ...it will be kicked out or edit stop it.
Well hope this info helps explain the workflow rationale
Lady T
 
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