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Medicare changing codes!

  1. #1
    Greeley, Colorado
    Thumbs down Medicare changing codes!
    Medical Coding Books
    Here's a new one - We submitted 99397 to Medicare in order to get the denial for the supplement. They CHANGED our code to to the IPPE code G0344!! No EKG was performed AND the patient was past his 6 month window. The carrier is TrailBlazers. They told our rep the EKG was not required and that they have "they right to make that change"! For one, there are specific guidelines and documentation that must be met for G0344 and the Medicare manual specifically states that by STATUTE the EKG (G0366) MUST be performed! I am so frustrated with TrailBlazers. They make more mistakes than I have ever encountered in my 10+ years of coding and dealing with Medicare!

    Sorry - had to vent.
    Lisa Bledsoe, CPC, CPMA

  2. #2
    We have submitted a 99397 with a GA modifier (the patient had signed a waiver) to Medicare and have not had any problem with Trailblazer. I wonder if the modifier would have made a difference in this case.

    Just a thought.....

    Teresa Collins, CPC

  3. #3
    Greeley, Colorado
    That's a good point, but I would use GY (you don't need an ABN for 99397). However, they should not be changing our codes...that's my frustration.
    Lisa Bledsoe, CPC, CPMA

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