Cardiology Coding Alert

Question: Why do private carriers such as Blue Cross/Blue Shield and Aetna always deny code 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) when we bill 99141(Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) or 99142 ( oral, rectal and/or intranasal)?We typically bill 99214-25, 93000, 93303 (Transthoracic echocardiography for congenital cardiac anomalies; complete),+93325 (Doppler echocardiography color flow velocity mapping), +93320 (Doppler echocardio-graphy, pulsed wave and/or continuous wave with spectral display) and 99141 all in-office on the same day. Insurance will pay the sedation code but bundles the EKG code with the sedation. We appeal and explain that 93000 shouldn't be considered as the single lead cardiorespiratory monitor, which is part of the echo. What is the proper way to bill the above?

Texas Subscriber

Answer: You should use modifier -59 (Distinct procedural service) in this scenario. However, the documentation must show that the cardiologist did not perform the 12-lead EKG with the echocardiogram. Separate documentation and the medical necessity for both tests should be very clear in the medical record.