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Primary Care Coding Alert

Annual Visits:

Ensure Correct Modifier Reporting for EKG With Annual Visit, or Face Denials

Published on Tue Sep 13, 2011

Heads up: New Medicare stance steers you away from modifier 25. If your family physician routinely orders an EKG as part of patients' annual visits, double check your modifier reporting before filing claims. Medicare now requires a modifier on claims reporting EKGs as part of a patient's annual wellness visit (AWV) for dates of service on or after July 1, 2011. Scenario: You submit a claim to Medicare with G0438 (Annual wellness visit; includes a personalized prevention plan of service [PPS], initial visit) and EKG code 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). Medicare pays for G0438, but denies the EKG on the grounds that your claim either includes an invalid modifier or is missing a modifier. "When I called Medicare, they stated that a modifier is now required and it's not modifier 25," says Nancy Vento, office manager for Kenosha Family Practice in [...]
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