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EKG/Family Practice

  1. #1
    Default EKG/Family Practice
    Medical Coding Books
    i work for a family practice physician. a patient is having surgery; she had a pre-op exam, labs and ekg - everything was paid for but the ekg. i refiled with a 56 modifier on the ekg and that was denied as well. i didn't bother putting the 56 on the pre-op exam b/c they deny on that as well (we're talking medicare) this patient does not have a comorbid diagnosis that would cover an ekg normally like hypertension, etc. does anyone know how to get a pre-op ekg covered in these circumstances? any suggestion would help. Thanks!

  2. #2
    Location
    Daytona Beach
    Posts
    40
    Default Diagnosis
    You can use V72.81 per Medicare NCD. Hope that helps!


    Heather D Unklesbay, CPC,MA
    Office Manager

  3. #3
    Default
    I agree with the V72.8X codes look in your ICD-9 book and pick the appropriate code based on the issues involved in the pre-op visit. If you are going to use a modifier use the 25 on the consult code. We do not have any problems getting paid for our ekg's on pre-ops.

  4. #4
    Default
    Quote Originally Posted by cmcclatchey View Post
    i work for a family practice physician. a patient is having surgery; she had a pre-op exam, labs and ekg - everything was paid for but the ekg. i refiled with a 56 modifier on the ekg and that was denied as well. i didn't bother putting the 56 on the pre-op exam b/c they deny on that as well (we're talking medicare) this patient does not have a comorbid diagnosis that would cover an ekg normally like hypertension, etc. does anyone know how to get a pre-op ekg covered in these circumstances? any suggestion would help. Thanks!
    Your in the same boat with our office, we have that exact same problem with Medicare too, we've tried everything, they still consider it not medically necessary so we end up writing it off if the pt doesn't any comorbidities that are medically necessary.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Just to add to the discussion, you would not use modifier -56 on any part of the pre-op if this is for clearance performed at the request of the surgeon.

  6. #6
    Smile
    Quote Originally Posted by cmcclatchey View Post
    i work for a family practice physician. a patient is having surgery; she had a pre-op exam, labs and ekg - everything was paid for but the ekg. i refiled with a 56 modifier on the ekg and that was denied as well. i didn't bother putting the 56 on the pre-op exam b/c they deny on that as well (we're talking medicare) this patient does not have a comorbid diagnosis that would cover an ekg normally like hypertension, etc. does anyone know how to get a pre-op ekg covered in these circumstances? any suggestion would help. Thanks!

    V72.84 is the correct ICD 9 code to use...You stated that pt didnot have another diagnosis but "why is he having surgery" that could be another dx code....

    NO modifier should be used....


    Hopefully you are using consult cpt codes (9924_) for the visit....


    YTH,CPC

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