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99212-25 with 93000 & G0438 without modifier 25 with 93000

Chibelle Posted Tue 20th of September, 2011 18:11:14 PM

Per Medicare above procedure/service requires a qualifying service/procedure be received and covered. CPT 93000 is not covered when performed during the same session/date. Does that mean we cannot perform 93000 with the visit, whether routine or problem visit? Did this ruling take effect recently.

SuperCoder Answered Tue 20th of September, 2011 20:30:07 PM

When billed G0438, cpt 93000 usually gets denied as it is considered a preventive service. Even though, G0438 is now a payable service, but the basic nature of the service provided is considered preventive. So, when EKG is billed along with it gets denied.
So, it is always preferred to schedule such service on different DOS, otherwise would result denial.

Leslie Answered Wed 18th of April, 2012 21:31:25 PM

Try using modifier 59 with an underlying cormobidity
eg. 93000 -25 401.1

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