Wiki ECHO's being denied with E/M same DOS

[KORBISCHM]

My practice has been having all inpatient visits with echo interps being denied. It is mostly BC/BS and the reason for the denial they have has two parts. The first part is the line out of CPT for Medical Decision Making which states," amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed, and analyzed." They are stating that the echo interp is a global and should be part of the inpatient visit and we should go from the time the echo was ordered, to interpreted, to the patient visit and add all the time together and code it that way.

The second reasont they are denying it is another line out of CPT in the echo section which states, "report includes an interpretation of all clinically relevant findings including quantitative measurements obtained, plus a description of any recognized abnormalities. Pertinent images, video tape, and/or digital data are archived for permanent storage and are available for subsequent review. Use of echocardiography not meeting these criteria are not separately reportable.

Our ECHO's do meet the qualifications for reporting separately and the above statement for E/M has me very confused on their interpretation of the CPT book. Does anyone have any advice or recommendations for help to get all the procedures covered?

 

[Marybeth]

the e/m and echo should pay if you have a 25 mod on the e/m and a 26 mod on your echo. I do them all of the time and have not problem. Both with payable dx

99213/25
93306/26

 

[mitchellde]

I believe the difference here is the POS being inpatient for the posters question.
If the inpatient encounter is to go over the results of the echo then you may not code that separately, that is what the payer is telling you with the quotes from the CPT book.
Your encounter would need to contain complexity and exam beyond the reporting of the results.