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MCR denial for 93272

Marita Posted Mon 13th of May, 2013 18:24:11 PM

Physician billed /93272/ & /99233/ while patient was in hospital. All charges for /93272/ were denied. Am I missing a modifier?


I wrote in previously with the following question: What is the appropriate code for daily physician interpretation & written report of telemetry of patients in monitored units? Physician previously used 93014 which has been deleted.
Please Advise.

This was the answer given by supercoder:
93014 has been replaced by 93268-93272.
The parent code in this series, 93268, reads, patient demand single or multiple event recording with presymptom memory loop, per 30-day period of time. This parent code includes transmission, physician review and interpretation. If you are performing just the recording portion (includes hook-up, recording, and disconnection), then you only report 93270. If you are reporting monitoring, receipt of transmissions, and analysis then report 93271. If you are billing only for the physicians review and interpretation, then report 93272. If you perform all the subcomponent procedures, you should bundle them together and report 93268.

SuperCoder Answered Tue 14th of May, 2013 16:12:02 PM

It sounds like there needs to be a clarification of the services being coded.

Code 93014 has been replaced by 93268-93272. The question is whether these codes, used for outpatient diagnostic tests, are appropriate for the services you’re coding. Inpatient monitoring is likely to be included in the E/M service.

Checking a sample cardiac event detection LCD (CGS Admin, Part B, L31858) shows:
* Cardiac event detection is not covered for patients in hospitals, emergency rooms, skilled nursing facilities or other specialized facilities and will be denied as not medically necessary.
* Cardiac event detection is not covered for either outpatient or facility-based cardiac monitoring.

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