Wiki Where's the documentation??

[puggles]

Here's the situation...

A patient was seen in the office and at that time an EKG was done. It was determined that the patient needed to be admitted to the hospital to rule out an MI. So, we billed the insurance company the EKG code 93000. However, the insurance company, two years later, is coming back and recouping the EKG money. They state that a 93000 along with a 99219 can not be billed on the same date of service. I know that an 99212 can not be billed with a 99219, but I was always told that any lab work or testing can be billed even though a patient was admitted to the hospital.

However, I CAN NOT FIND ANY DOCUMENTATION REGARDING THIS!! If some one could PLEASE help me, you would be a lifesaver. Thank you!!

 

[gherimicheleCPC]

Who is the payor? Did you use a 25 modifier on the 99219?

 

[puggles]

Humana and no mod 25 used

 

[gherimicheleCPC]

I would rebill it as a CC and add the modifier. The EKG should be paid. It's really funny how we get denied on "timely filing" but they can come back after two years....I would appeal them on this all the way...just to make a point because the $$$$ isn't that much...it's the principle.