Author Topic: Getting paid for ekgs when pt is in-pt  (Read 1983 times)

jaycee

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Getting paid for ekgs when pt is in-pt
« on: July 07, 2008, 09:13:03 AM »
Ok so we are lost on this one. We have tried modifiers and everything we can think of to get paid. Here is the problem:
                     If our Doctor sees one of our patints while they are IN-PATIENTS at the hospital and performs an ekg with report (93000) medicare will not pay us for the ekg. Are we billing this wrong? Any suggestions.    ???

Michele

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Re: Getting paid for ekgs when pt is in-pt
« Reply #1 on: July 10, 2008, 09:42:23 AM »
Hi,
   You said you've tried modifiers, but you didn't mention what ones.  I would have said that you would bill 93010 - interpretation & report only, and even put on the 26 modifier to suggest professional component only.  Although the 26 shouldn't be needed since the description states interpretation & report only. 

   If you 've already tried that but it didn't work, post again, and we'll see if anyone else has had this issue.

Thanks
Michele
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jaycee

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Re: Getting paid for ekgs when pt is in-pt
« Reply #2 on: July 10, 2008, 01:17:58 PM »
What we are having trouble with is the 93010. If the doctor sees a patient for E/M hospital care and performs the EKG (93010) we sometimes do not get paid for the EKG because the insurance company states that "this procedure is included in a procedure already paid for on the date of service". We are hoping you can help us code correctly. We thought that maybe we should use modifier 26, but that one does not always work. Our billing company has been trying to use modifier 59 (no EOBs received back as of yet). I always thought that modifier 59 was "the modifier of last resort".

Thank you in advance for your help.

Michele

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Re: Getting paid for ekgs when pt is in-pt
« Reply #3 on: July 14, 2008, 12:18:35 PM »
It sounds like your doing everything right.  The only option left is the 59 modifier.  It does sometimes seem like that is the "modifier of last resort" but it is actually a good option. 

You may find that some insurance carriers just do not allow the EKG reading in addition to the E&M code and even the 59 modifier won't help.  But I would recommend using it, it may get the charges paid correctly.

Good luck
Michele
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