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EKG with Welcome to Medicare px

  1. #1
    Default EKG with Welcome to Medicare px
    Medical Coding Books
    I was wondering if anyone else is having a problem getting paid for an EKG at the Welcome to Medicare px? I have tried G0403 and 93000. I have used V81.2 and/or 401.9 and it is still denied. I am at a loss. Thank you!

  2. Default Getting paid for the Wellcome to Medicare EKG
    Our office uses the G0403 with V70.0 and we have had no problems getting paid as long.

  3. #3
    Oh my thank you! Are you using a modifier -25 on the G0402 for the G0403? I read not to use the modifier but I thought I would ask you. One more thing. When you bill for the G0438 and G0439 how are you billing the screening EKG? Or is there no screening for the G0438 and G0439? Jeez. Thank you again.

  4. #4
    Hendersonville, NC
    You don't need a -25 on the G0402.

    And there is no screening EKG for the G0438 and G0439. The 'free' EKG is only with the IPPE (G0402).

    If there is a medical need for an EKG during a wellness visit then it would look something like:

    G0439 V70.0
    99213-25 401.9
    93000 401.9

  5. #5
    I'll be interested to see if you can get this to work. I work at a hospital with provider-based clinics paid under the OPPS and our G0402/G0403 code pairs are getting denied for place of service. I bumped into this bit of information:

    We are now trying a G0402-25, G0404 trial on a claim based on the information in the bulletin to see if it will finally meet Medicare's standards.
    Last edited by Patrick07; 09-13-2014 at 07:06 PM.

  6. #6
    Hendersonville, NC
    Patrick, according to the MLN you linked what you are doing should go through. Let us know!

  7. #7
    Thank you so much!!!!!!!

  8. #8
    I will certainly report my findings; our test balloon went out on Thursday the 12th so it's only been a few days. If anybody else has any positive results to share, I'd like to her them as well.

  9. #9
    G0404 denied again. Place of service again. I feel like that paperboy in the movie Better Off Dead with John Cusack, "Medicare, I want my two dollars!"

    I was talking to a member of our Follow Up team and they noticed that the patient eligibility screen in C-SNAP identifies G0404-TC as a benefit. Since we've failed in so many other ways,we are now going to try G0402-25, G0404-TC and see if we get any traction.

    YouTube Better Off Dead

  10. #10
    Roanoke, Virginia
    What was the final outcome? I've always used the G code with no modifier and diagnosis V70.0 (POS code 11 for office setting). I don't see how a 25 modifier would work, but good luck!


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