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multiple proc/same dos

  1. #1
    Question multiple proc/same dos
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    Need some help, our Dr.(FP) did a ov, ekg and earwash all in one day in the office...it was submitted as

    OV-proc 99213/25 DX 7804
    Earwash proc -69210 dx 3804
    EKG proc 93000 dx 7804

    this came back with ov pd and earwash paid but the EKG was not paid...so...the insurance person refiled the EKG as proc 93000/25 and this too came back denied due to modifier...

    How should this have been submitted so the Dr can get pd for all??? Modifier 51???

    Any feedback will be appreciated!!!

  2. #2
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    The modifier 25 only goes on E/M codes not on anything else.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  3. #3
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    Quote Originally Posted by Patricia L Diaz View Post
    Need some help, our Dr.(FP) did a ov, ekg and earwash all in one day in the office...it was submitted as

    OV-proc 99213/25 DX 7804
    Earwash proc -69210 dx 3804
    EKG proc 93000 dx 7804

    this came back with ov pd and earwash paid but the EKG was not paid...so...the insurance person refiled the EKG as proc 93000/25 and this too came back denied due to modifier...

    How should this have been submitted so the Dr can get pd for all??? Modifier 51???

    Any feedback will be appreciated!!!
    First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure.
    Second the 25 is used only on the E&M code
    third what was the denial reason for the EKG on the initial submission?

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default
    I agree with you debra in regards to the 69210.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  5. #5
    Default
    Quote Originally Posted by mitchellde View Post
    First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure.
    Second the 25 is used only on the E&M code
    third what was the denial reason for the EKG on the initial submission?
    sorry...I did not use the proper definition..."First the 69210 is a procedure code for an impacted cerumen removal which must be performed by the physician or NP using a scoop or currette it is not an ear irrigation procedure." I too agree with this, the EKG was denied on the initial submission due to..

    #1 -"Submission/billing error (s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code)" (code 125 on EOB)

    #2 (code M15 on EOB) "Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

    Any comments/advice?

  6. Default
    WE recently submitted an office visit with mod 25, 69210 done by the physician and documented, and EKG. It was stopped byour clearing house because:" the combination of 69210 and 93000 violate the NCCI policy for component codes".

    My ? is shouldn't the modifier 25 cover this?
    Thanks for any input

  7. #7
    Default
    Code 93000 is a component of code 69210 but a modifier is allowed in order to differentiate between the services provided.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

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