# need help from the billing veterans/specialists



## ollielooya (Sep 28, 2010)

New patient visit 99205 for Nevada Humana/Gold patient being seen by our specialist with dx. 346.11 and 728.85.  Also EKG 93000 with dx 786.05.  Billed out:  *99205-25, 93000*.  Humana pd 93000 but denied the office visit stating HCPCS modifier is missing/invalid.  Upon follow up was told MCR no longer allows the two to be billed with a modifier 25.  Did (have) I missed something?  I do remember reading back sometime ago a thread concerning whether or not this can be done with such a high level visit but this is the first time such a denial has impacted us.   Enlightenment, advice and discussion welcomed, secondary to "administrative necessity (?) ---Suzanne


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## southbaymed (Sep 29, 2010)

we are in CA, no modifer rq for EKG along w/EM; however, 786.05 is not covered for
EKG, 786.50 is covered.  We have never bill w/786.05 for EKG


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## ollielooya (Sep 29, 2010)

Thank you for taking the time to reply to my question.  It was helpful.  ---Suzanne


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