Wiki Echo/Stress Test with E&M

[ambsmedical]

Does anyone notice Blue Cross denying Echo and Stress Test readings as inclusive with the hospital visit, all of a sudden? Anything to do about it?

 

[GBielskis]

We are a cardiology practice in Michigan. McKesson edits for Blue Cross are stating that to us also. This just started happening recently. I understand MGMA is looking into this.

 

[Jess1125]

Does anyone notice Blue Cross denying Echo and Stress Test readings as inclusive with the hospital visit, all of a sudden? Anything to do about it?

I'm starting to have issues with this myself that I've needed the insurance department to send appeals on. (Haven't come across Blue Cross yet,though. It's been 2 other insurances)

I send a copy of a paragraph from the E/M guidelines which state:

"The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are NOT included in the levels of E/M services. Physician performance of diagnostic tests/studies for which specific CPT codes are available MAY BE REPORTED SEPARATELY, IN ADDITION to the appropriate E/M code. The physician's interpretation of the results of diagnostic tests/studies (ie, professional component) with preparation of a separate distinctly identifiable signed written report MAY ALSO BE REPORTED SEPARATELY, using the appropriate CPT code with modifier 26 appended."

Jessica CPC, CCC

 

[GBielskis]

Echo/Stress test with E & M

We are having Michigan Blue Cross deny for this. They use McKesson edits. ASE (American Society of Echocardiography) has sent a letter to McKesson objecting to this edit, based on the description in the CPT book that "decision making" does not include the actual diagnostic testing, but helps determine the level, along with information in the CPT book stating performance and interpretation of diagnostic tests/studies during a patient encounter are not included in the E & M.

This causes a large problem with us, as we do not bill our echos, stress tests and subsequent days for hospital billing at the same time. The reports come in first, then we bill subsequent days later.