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99291 and 93010

  1. #1
    Default 99291 and 93010
    Medical Coding Books
    I have a Dr who did the interp for ekg during critical care visit. It is my understanding that the ekg can be billed sep. but am seeing denials from ins. Per cpt, info stored in computer, 99090, which includes ecg, can't be billed but the ekg can correct??? Any clarification would be appreciated.

  2. #2
    We can bill 93010 with 99291

  3. Default
    I would like an answer to this as well. I am seeing this denial also and the bulk of my denials appear to be BCBS. Does anyone know if there are specific modifiers that should be used when these codes are billed together? Thanks!

  4. #4
    Kingsport, TN
    Default Critical Care
    In my opinion, an ECG and EKG both fall under Electrocardiography and according to CPT, "information data stored in computers (eg, ECGs," etc...) are included in reporting critical care and are not seperately billable.

  5. Default
    EKG interpretation (93010), performed and documented (we ask that they document at least 3-6 specific findings, comparisons) IS separately billable with critical care 99291. Check your CPT book for CPT codes included in 99291 and 93010 is not one of them. CPT 99090 Information data stored in computers IS included but I have never seen this in the ED. You may be seeing denials for some payers due to: 1.) They require a Modifier appended to the 93010, 2.) They may require a "linking" DX such as chest pain, SOB etc or 3.) They may just NOT pay for 93010. Hope this helps.

  6. Default 99291 and 93010
    You may have to appeal, so that a person in medical review will look into this. Many of the insurance company edits are automated, and denied by the computer system, not by a person. Write a brief letter, and submit a copy of the documentation. Good Luck.

  7. Default
    I am having this same problem as well with 93010. Aetna is denying these as bundled. Is there a modifier that should be used if it is being billed separately?

  8. Smile
    Try modifer 25.

  9. Smile CDcoder
    I believe you would bill both the 99291 and the 93010 if the ED DOC has documented at least 3 or more of the 6 readings and apply the modifier 26 to the ekg.

  10. #10
    Do not put a modifier 26 on 93010 as this code is already for the interpretation and report only. Make sure you are linking the 93010 to an acceptable diagnosis code then add modifier 25 to the EM. 99291.25 93010 that should do it.

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