Pediatric Coding Alert

For insurers that follow Correct Coding Initiative (CCI) guidelines, start using modifier 59 on same-day electrocardiogram (ECG) and unrelated procedure claims, like wart and impacted cerumen removal -- or lose your $21* diagnostic charge.

Since April, Medicare has denied ECG code 93000 on three claims that also involved a procedure, reports Sherry Morshedi, RHIT, practice manager for Benny J. Green, MD, PA, in Little Rock, Ark. "Medicare advised me to use modifier 59 on the ECG."

CMS has expanded its global surgical package inclusions. To close a loophole that may have allowed physicians to report a routine pre-surgery ECG separately from a procedure, CCI 15.1, effective April 1, placed a blanket bundle on most surgery codes, minor and major.

The bundles contain a modifier indicator of "1," meaning you can break the edits provided the pediatrician performed the ECG as distinctly separate from the procedure. "You have to ask yourself are the two normally bundled procedures, done at different anatomical sites, such as different injuries or different organ systems," says Barbara Cobuzzi, MBA, CPC, CENTC, CPC-H, CPCP,CIMC, CHCC, president of CRN Healthcare Solutions in Tinton Falls, N.J.

CCI 15.1 bundled the following codes into numerous procedure codes, including removal of impacted cerumen (69210) and in/out catheterization (51701):

• 93000 -- Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

• 93005 -- ... tracing only, without interpretation and report

• 93010 -- ... interpretation and report only.

To break a bundle for an ECG that is unrelated to another procedure, you'll need to use modifier 59 (Distinct procedural service) on the test code. This indicates that the pediatrician performed the ECG for a separate reason, not as a routine pre-surgery test.

Example: A child has a wart removed (17110, Destruction [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement], of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions) and also complains of chest pain.

The pediatrician takes an appropriate history, performs an appropriate exam, and orders an ECG to evaluate the patient's chest pain (ECG). The pediatrician interprets the ECG as revealing no heart-related problems.

Because the ECG is for a different reason than the wart removal, you can report both procedures. Append modifier 59 to 93000 to indicate it is a distinct procedural service from 17110. Link the related diagnoses to each procedure:

• 078.10 (Viral warts, unspecified) to 17110

• 786.59 (Chest pain; other) to 93000 to represent the patient's complaint.