Wiki cpt 93306 & 93308 plus mcaid question

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thejewel

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Greetings,

Have anyone had a problem with a carrier changing cpt 93306 to 93308 if it was billed within a 6month period. The carrier stated that only 1 for every 6month if same dx is being used. And if another was billed they will change it to 93308 and use it as a f/u.

I have not done mcaid billing in a while so I have a question. If mcaid was billed and they denied the claim for out of network can we bill the pt? Mcaid was not check to see if pt was eligible for that month.
 
We haven't had a carrier change the code, but we have had denials. You then have to appeal and show why the need for another test within the 6 months..IE: recurrent/ worsening chest pain.. abnormal ekg(changes from previous ekg)
 
thejewel said:
Greetings,

Have anyone had a problem with a carrier changing cpt 93306 to 93308 if it was billed within a 6month period. The carrier stated that only 1 for every 6month if same dx is being used. And if another was billed they will change it to 93308 and use it as a f/u.

I have not done mcaid billing in a while so I have a question. If mcaid was billed and they denied the claim for out of network can we bill the pt? Mcaid was not check to see if pt was eligible for that month.
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I do have a certain commercial insurance payor who won't change the 93306 but will give us payment instead for what they pay us for 93308. I've heard that if a complete echo was done in the last 6 months we can't bill for a complete again (according to insurance)Personally, I haven't seen this in writing ever in the 12 years I've been doing cardiology coding that there's a frequency limitation on a complete echo. I usually transfer the acct to commercial insurance staff to question this.

Jessica CPC, CCC
 
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