Results 1 to 7 of 7

office visit and EKG to Medicare

  1. Red face office visit and EKG to Medicare
    Exam Training Packages
    Medicare is denying our EKG that was done with an office visit. Is ther a specific modifier that should be added to the EKG? I've worked OB/GYN for years new to Family Practice. thanks

  2. #2
    Default
    my experience has been that they consider it bundled into the E/M. We would bill with 25 and 59

  3. #3
    Location
    Paducah Kentucky
    Posts
    16
    Default ekg
    We are paid by Medicare when we bill E&M and EKG with no modifier, but we do put the ordering physicians name on the claim(referring provider on our software). Also, the diagnosis must meet medical necessity. For example, Medicare will not pay for an EKG for pre-op clearance.

  4. #4
    Location
    Weston, FL
    Posts
    10
    Default
    Quote Originally Posted by gsharma View Post
    Medicare is denying our EKG that was done with an office visit. Is ther a specific modifier that should be added to the EKG? I've worked OB/GYN for years new to Family Practice. thanks
    What is the reason for the denial ? The Ekg should be sent in with a modifier 25, but also make sure that the diagnoses code is consistant with the procedure.

  5. #5
    Default reason for ekg?
    CMS chapter 12 section 30.6.2 addresses EKGs during a preventative medicine services stating

    "procedures which are for screening for asymptomatic conditions are considered noncovered and therefore, no payment is made. Those procedures ordered to diagnose or monitor a symptom, medical condition or treatment are evaluated for medical necessity and, if covered, are paid."

    http://www.cms.gov/manuals/downloads/clm104c12.pdf

    Section also addresses furnishing a covered vist at the same place and on the same occasion as a noncovered preventative medicine service.

    Does the documentation demonstrate the medical necessity of obtaining an EKG?
    Last edited by jackson7591; 07-28-2011 at 06:31 PM.

  6. Unhappy Ekg denials
    We are a cardiac practice, we bill an E/M with modifier 25 and diagnostic EKG. The referring provider is our cardiologist. Claim is denied "referring provider is not eligible to refer these services:. We changed the referring provider to the PCP that sent the patient to our practice. Claim again denied for the same reason. Any suggestions. I thought you did not need a referring provider when the service was performed in your office.

  7. #7
    Location
    Columbia, MO
    Posts
    12,570
    Default
    Quote Originally Posted by brookeborne View Post
    We are a cardiac practice, we bill an E/M with modifier 25 and diagnostic EKG. The referring provider is our cardiologist. Claim is denied "referring provider is not eligible to refer these services:. We changed the referring provider to the PCP that sent the patient to our practice. Claim again denied for the same reason. Any suggestions. I thought you did not need a referring provider when the service was performed in your office.
    Perhaps it is the qualifier you are using or lack of qualifier in field 17. And yes the referring physician field (17) needs to be populated even if performed in your office. That is why they created the qualifiers.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. EKG Medicare Incident-to Office Setting?
    By jlb102780 in forum Medicare Regulations
    Replies: 0
    Last Post: 04-23-2014, 08:03 AM
  2. Office visit with Echo 93306 & EKG 93000
    By suzannec83@hotmail.com in forum Cardiology
    Replies: 1
    Last Post: 08-06-2013, 03:56 PM
  3. Office visit and EKG
    By coders_rock! in forum E/M
    Replies: 1
    Last Post: 03-15-2013, 10:38 AM
  4. office visit, echo and ekg
    By tdnguyentx in forum Cardiology
    Replies: 4
    Last Post: 12-06-2012, 05:32 PM
  5. EKG/Surgery with office visit
    By joglesbee in forum E/M
    Replies: 6
    Last Post: 08-11-2009, 10:02 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.