Wiki EKG w/ Pacemaker interrogation

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mramirez88

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I have been billing an EKG CPT 93000 and pacemaker interrogation CPT 93280 on the same day. I have been using a modifier 25 for the E/M code and modifier 59 on the interrogation CPT 93280. The EKG 93000 has been denied stating that the interrogation includes EKG (NCCI edits preclude billing an EKG at the same visit) and will not be paid separately even with adding modifier 59. My EP cardiologist states that the pacemaker interrogation does not evaluate the QRS waves. QRS waves are show if the patient is having any blockages in the heart. This is the reason for EKG on the same day. I have sent in an Appeal with this information and the claims are still denied. Has anyone else been having this same issue?
 
Hello everyone,

I see this is an old post but checking to see if anyone is facing the current issue what we have now.


Medicare denial :

For the same DOS,
E/M - Modifier 25 given
EKG - 93000 - Billed with modifiers 59.
Device checks(PM/ICD) - CPT code range 93279 - 93284, 93294 - getting denied as inclusive/bundled.

We tried with modifier XU/XS for 93000 but denied still.


Any advice?
 
vidraj said:
Hello everyone,

I see this is an old post but checking to see if anyone is facing the current issue what we have now.


Medicare denial :

For the same DOS,
E/M - Modifier 25 given
EKG - 93000 - Billed with modifiers 59.
Device checks(PM/ICD) - CPT code range 93279 - 93284, 93294 - getting denied as inclusive/bundled.

We tried with modifier XU/XS for 93000 but denied still.


Any advice?
Click to expand...
per the NCCI edits, -25 modifier is NOT needed on the E/M
 
We have been using modifier 25 - for all Office visits when any procedure is performed (EKG, Echo, Device checks).

Isn't that still active?
 
Modifier -25 is not required when an EKG is done.

I checked the NCCI edits for the 3 'device check' codes, that you listed above, against an E/M and they do not require a -25 modifier, either.

but the EKG did run up against an edit with all 3 'device check' codes, so the -59 modifier, seems valid.
 
Yes, I agree with you on this - "not all 'procedures' require a -25 modifier with an E/M".

I did come across this another forum discussion where they mentioned about using XE modifier - (https://www.aapc.com/discuss/thread...vice-evaluation.168128/?view=date#post-461387)

XE - Separate encounter, a service that is distinct because it occurred during a separate encounter

If the EKG was done at a different time on the same day you can bill for it...but not as part of the PM check.
We add the modifier XE to the EKG and add the time it was done in the additional info line.

Is anyone familiar with appending XE modifier for 93000?
(As in our denial claims, the EKGs were done for other diagnosis and not as a part of device check. Appending XE seems correct to show it is distinct).

Would like to hear some inputs on this...
 
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