Wiki EKG Issues

[joglesbee]

I have been trying to file this claim with medicare several times and have continued to have some billing issues. Medicare continues to return this saying that the EKG is bundling with another aspect of the service. I am trying to figure out how to file this succesfully. All other parts of the visit have been paid with the exception of the EKG.

99212 25
93005
93010
36415
69210 59

 

[eadun2000]

My first question is why are you billing 93005 and 93010? If you did the tracing and the interpretation and report it should be 93000. Secondly, I am surprised that you are billing a 99212. Was the documentation that lacking?

 

[joglesbee]

I our office is never able to file the combined code with medicare the 93000, medicare always rejects the codes when we file with this, but when we unbundled the code to 93010 and 93005 we are able to get them paid. This is the only patient we are having problems with.

 

[krburke]

Hpsa?

Are you located in a HPSA or PSA? I used to bill for a doctor in one of the HPSA zip codes, and even though she was performing both the technical and professional components of the EKG, Medicare would only pay the HPSA bonus on the professional component, and they could only process those codes when they were filed as separate components--claims filed with 93000 would be denied. I know it sounds crazy and defies all the logic we learned as coders, but I filed them that way because those HPSA payments added up!

Have you asked your Medicare carrier (MAC) to tell you which code it is bundled with? They generally can't give coding advice, but if they're telling you it is bundled, they should be able to tell you which code it is bundled with.

 

[joglesbee]

we are located in a hpsa and that is why we bill seperate because there is more money in it. I haven't asked them which specific code it is bundling with maybe that will help me find a way to get this to work.