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Multiple EKGs on the same DOS

  1. #1
    Default Multiple EKGs on the same DOS
    Medical Coding Books
    Our providers in New York sometimes perform several EKGs on the same day due to patient conditions, are we supposed to bill in 1 line with multiple units or bill with modifier 59 or 76 in multiple sides. Normally how many EKGs are covered by insurance?

  2. #2
    Default Modifier 76
    Modifier 76 would be appropriate (or 77 if performed by a different physician) for the additional EKG's.
    As to the "how many are covered" issue, for most carriers this is simply a medical necessity issue. From a clinical standpoint, it is sometimes necessary to perform several EKG's on the same date of service (for instance, after a cardiac drug is given to assess the effectiveness of the intervention). If the additional units are denied, I would appeal with the reports (make sure they list the reason the EKG was performed).

  3. #3

    What about NY Medicare carrier? I said our providers are from NY.

    You are saying use mod 76 and then additional units, that's contradicting??

    Our providers doesnt perform multiple EKGs without medical necessity

  4. Default multiple EKGs on same date of service
    We are in Upstate NY:
    We bill a single unit/claim for each EKG. The first EKG billed gets no modifier. The second EKG billed gets a 76 or 77, depending on whether it was read by the same physician or a different physician. Third gets a 76 or 77 and so on.
    So if they had 2 EKGs, then there would be 2 lines: One without a modifier and one with. If they had 3 EKGs, then there would be 3 lines: One without a modifier and 2 with.
    Everyone is paying us just fine.

  5. #5
    Great we are doing exactly the same, only that we are running into problem when we several more than 3 EKGs done on a single day...


  6. Default Additional question on mods
    Input please! So the scenario I'm seeing is Ekg charges 93005 with modifier 76- and then patient has a stress test. I don't feel it is appropriate to add a modifier 59 IN addition to modifier 76. Can someone direct to the guidelines that clarify?

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