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annual

Paula Posted Wed 13th of August, 2014 12:39:38 PM

We are getting denials on EKG 93005 and 93010 with annual. we are using the dx code v700. If this is not the correct dx code please help me with the correct preventative dx code for the insurance carrier to pay. patients are angry that these are not getting covered.
Insurance carriers are stating not preventative if they have billed dx code 4011 prior. what would the dx code used for annual in this case
Can you also give me Medicare's G0439 for est. preventative exam v700. for EKG 93005
We are also getting the denials for exams with EKG stating "part of exam" even with leg/joint pain dx. is also used. bcbs is really cutting down on payments and making us appeal decisions. The EKG test is important to do for our patients.

SuperCoder Answered Thu 14th of August, 2014 09:56:01 AM

Thanks for your question. EKGs are covered under most insurance companies as a preventative service. United Healthcare, BCBS, and Medicare policies all cover EKGs under preventative benefits. You may need to check the patient's specific plan to determine why the insurance company has actually denied the service. It just may not be a covered preventative service under their plan.

I agree with your insurance denial stating that a previous diagnosis of 401.1 cannot be coded with V70.0. It’s no longer just a routine service but a patient that has a condition that would cause heart related problems.

Medicare covers the EKG once during the “Welcome to Medicare Physical” and they also cover diagnostic EKGs at other visits. See attached links for additional information.

http://www.medicare.gov/Pubs/pdf/10116.pdf

http://www.connecticare.com/member/ManageAccount/memberservices/PreventiveCareFAQ.aspx#6

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MPS_QRI_IPPE001a.pdf

http://www.fepblue.org/benefitplans/basic-option/medical-benefits.jsp

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