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Thread: Re: 93010

  1. #1

    Exclamation Re: 93010

    AAPC: Back to School
    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.

  2. #2
    Join Date
    Apr 2007

    Default 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

  3. #3
    Join Date
    Apr 2007


    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.

  4. #4
    Join Date
    Apr 2007
    Milwaukee WI

    Default 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

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