Wiki Preventive visit with EKG

[ollielooya]

99396 - V70.0, 272.2
93000 - 272.2, V70.0
36415 - V70.0, 272.2

QUESTION: Is modifier 25 allowed on the EM due to the assignment of the EKG 93000, or is it not added as it is bundled due to the 99396 code descriptor? Does there need to be a different dx for the EKG?

If warranted, what can I use as supporting reference to validate the use of modifier 25? Is the use of the EKG really significant, separately identifiable E/M service ABOVE and BEYOND...etc, etc.?

Suzanne E. Byrum, CPC

 

[cmcgarry]

99396 - V70.0, 272.2
93000 - 272.2, V70.0
36415 - V70.0, 272.2

QUESTION: Is modifier 25 allowed on the EM due to the assignment of the EKG 93000, or is it not added as it is bundled due to the 99396 code descriptor? Does there need to be a different dx for the EKG?

If warranted, what can I use as supporting reference to validate the use of modifier 25? Is the use of the EKG really significant, separately identifiable E/M service ABOVE and BEYOND...etc, etc.?

Suzanne E. Byrum, CPC

A preventive visit does not "include" diagnostic tests, and a EKG is a diagnostic test. These should not bundle, and you shouldn't need a 25 modifier on the preventive visit code. Do you have an insurance company that is denying the EKG as part of the visit? I would direct them to the Preventive Medicine Services Guidelines right before the codes in the CPT, which states "Vaccine/toxoid products, immunization administrations, ancillary studies involving laboratory, radiology, other procedures, or screening tests identified with a specific CPT code are reported separately." I did run the codes through my compliance checker and didn't get an edit from CCI (of course, that's not to say that some insurance company doesn't edit it!)