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IPPE and EKG

  1. #1
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default IPPE and EKG
    Medical Coding Books
    We are getting denied for G0403. My understanding is that if there is medical necessity, the EKG needs to be referred as a result of the IPPE. Who do we refer to? Don't you need to have medical necessity for an EKG? Screening is wrong terminology in my opinion as screening EKG on NH LCD is non covered. I may be over complicating this.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
    Default
    Quote Originally Posted by kbarron View Post
    We are getting denied for G0403. My understanding is that if there is medical necessity, the EKG needs to be referred as a result of the IPPE. Who do we refer to? Don't you need to have medical necessity for an EKG? Screening is wrong terminology in my opinion as screening EKG on NH LCD is non covered. I may be over complicating this.
    I'm not 100% sure what you're asking, but -
    A routine EKG is included in the IPPE, but if there's medical necessity to perform an EKG (problem diagnosis), bill a 93000 with a 59 modifier, and your problem Dx, and it should pay. Hope that helps!

  3. #3
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    NHIC is telling us that " procedure not billable to fiscal intermediary" and we are using G0403. We are a CAH method II in New Hampshire.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4
    Location
    Seacoast- Dover New Hampshire
    Posts
    609
    Default
    any more takers on this?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  5. Default IPPE and EKGs G0404-5
    We are billing G0402 and, when indicated, G0403-G0405, with code V70.0. We are being paid for G0402 and G0403, but have not been paid on any patient for G0404-05. The denial is "Claim lacks information....use remark codes." Should we change the diagnosis code??? or add a modifier to G0402??? Anybody have any experience with this?

    Thanks,
    Louise Cook, CPC
    Atlanta, Georgia

  6. #6
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by Lancia1 View Post
    We are billing G0402 and, when indicated, G0403-G0405, with code V70.0. We are being paid for G0402 and G0403, but have not been paid on any patient for G0404-05. The denial is "Claim lacks information....use remark codes." Should we change the diagnosis code??? or add a modifier to G0402??? Anybody have any experience with this?

    Thanks,
    Louise Cook, CPC
    Atlanta, Georgia
    I would contact your local Medicare carrier to ask why the other EKG codes are not being reimbursed. As long as the provider is only doing a tracing, or only doing the interpretation and report, those codes are acceptable. But if any other provider is billing the global code G0403, they will deny the other two codes.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

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