Wiki 59 on EKG read in hospital

[medihedgie]

When an EKG is done in the hospital is there a 59 modifier needed for the reading physician? I am coding ekg reads only. Is it 93010-59 or can it just stand alone? Actually same question for Echo reads...93306-26 or 93306-26-59.
Please... I'm being looked to as the lady with the answers and I'm not so confident. The big question I have is really..the system is automatically slapping a 59 on all the 93010...will they kick back as wrong if the 59 is not needed?

 

[kreuschle]

93010 (interpretation/report for EKG) does not necessarily need 59 modifier on it, but it is something that may be appropriate if an EKG was done as a separately identifiable and medically necessary separate service from something it would normally be bundled into (stress test for example). Same for 93306-26: there may be a situation where 93306-2659 is appropriate, but i would never just always put on the 59 modifier.

 

[KNuttle]

I would use modifier 26, interpetation only. I use to code for a Internal Medicine Doctor. He would go into the Hospital and read EKG reports. Not sure if this is what you are coding for. But it worked for me. At least, this is how Medicare instructed me to code.

 

[Pam Warren]

If billed independent of another charge, you do not need a modifier for the EKG read code, 93010. This code is specifically for the read, so you would definitely not use the -26.
If the provider also did an echo read or another diagnostic interpretation on the same day, you may have to use a -59, but that would be the only reason. The same goes for the echo reads, these are specifically professional charges, and you wouldn't use a -26.

If you do several reads for the same patient on the same day, you'd add a modifier -76.

Overuse of the -59 is a Medicare red flag. Any automatic modifier usage is a bad idea.