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Debra Posted Wed 15th of July, 2015 13:58:38 PM

On 1 day of service, I billed 99214-25, 93000, and 11400-59 to Medicare. 93000 was denied for a qualifying service/procedure that was not previously billed/adjudicated. How should I have billed this visit? Can you explain this denial?

SuperCoder Answered Thu 16th of July, 2015 03:37:51 AM

Well, in this kind of scenario you need modifier 25 to indicate a signficant, separate EM from the EKG (correctly done in your case). Some systems have an auto edit that kicks out a procedure with an EM unless 25 is used. You would use a 59 if you were billing the EKG and a procedure that the EKG is considered a component of- such as wart removal. Based on global surgery guidelines, a related ECG is included in most same day surgery codes. You can bill for unrelated ECGs and procedures by indicating the EKG is unrelated to the procedure with 59 on the EKG. Hence you have to give modifier 59 with 93000 instead of CPT 11400. Hope it helps!

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