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ECG's '93000' denied by Medicare

Tammy Posted Sun 25th of October, 2009 16:24:00 PM

Someone please advise the correct way to bill an ECG '93000' for family practice with Medicare for a non-preventative exam. Which modifier? DX is usually chest pain, shortness of breath, etc. Should it be the G code for this type of visit? Is the CLIA required on the claim?

SuperCoder Answered Tue 27th of October, 2009 12:28:01 PM

Medicare provides only one IPPE with EKG per lifetime of the member (reporteed by G0344 and G0366 - G0368). Since this is not a preventive examination it will not be covered by Medicare.

Deborah Answered Sun 01st of November, 2009 17:20:27 PM

We have a satelite office that we have to break down "93000" into "93005" and then "93010". it is because of the zip code of the office for some reason. none of our other satelite office have this problem. As long as there is a payable diagnosis code linked to it. and chest pain and shortness of breath are typical diagnoses.

SuperCoder Answered Wed 04th of November, 2009 05:48:14 AM

CPT 93000 tagged with the stated primary symptomatic illness appears to be the most appropriate way to code the service you've described. Also, I am not aware of any other code that Medicare or other payers would direct you to use in this situation. In fact, Medicare reimbursed code 93000 almost million times in these following years which would not be the case if the code was not to be used with symptomatic patients.

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