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Medicare denying 93005

  1. Default Medicare denying 93005
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    Coding Gurus..Please help...I need assistance regarding Medicare denials of my claims for CPT Code 93005 - Is there a modifier I should use for this or another code similar to this: Our Physicians apply this procedure they have a machine that reads/interprets the report right then and there so it is not read separately by another source.. thx ct

  2. Default
    I did a CPT inquiry in my Medicare system and it is showing as type M which is not billable to an FI. However, it has an APC indicator of S which means it is separately payable under OPPS. I don't believe that there is a modifer that can be added to the code as the description itself states w/o 'interpretation and report'.

    Also, you stated that they have a machine that reads/interprets the report. Per CPT Guideline, if the 'report is separate, signed, written and retrievable' then CPT 93000 can be used.

    Try calling Medicare customer service. They may have to send it over to their EDI dept to review.

    Hope this helps.

  3. Default
    My understanding of EKG codes is this: CPT 93005 as the TC component of an EKG -- 93000 as global (doctor owes equipment & does their own DX (report) and 93010 if a doctor does int & report only

  4. Default
    Forgot to mention: the POS should be considered when using 93005 as this is a TC code.-ie, is this a hospital based facility?
    93000 would be a "private office"

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