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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.
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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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