Wiki Rounds and Echos

[daphne.murphy@sbcglobal.net]

We have been hearing that Medicare is cutting echo hospital readings (93306,26) if the same doctor rounds on the same day (99233,299232,99231). Is there any truth to this and if so, is there a policy from Medicare? Also, can we use a modifier 25 to show that it was a seperate service?

 

[KORBISCHM]

Inpatient rounds with echo interp

I work with pediatric cardiology where the physicians take turns being on call and who ever is on call will interpret the echos and when needed consult on an inpatient same day. I was getting denials from BC/BS as they were stating the reading was incidental to the primary E/M procedure. I found the wording in the CPT book and fought it and was able to get them to change policy which should be taking effect this month. The wording is on page 6 of the CPT professional edition book. It was a long fight but I was able to get them to change their policy and recouped over $40,000 in denied echo interps. It states," 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 additionto the appropriate E/M code. The physician's interpretationof the results of diagnostic tests or studies with preparation of a separate distinctly identifiable signed written report may also be reported separately using the appropriate CPT code with modifier 26." It also states that if they consult on that patient to append the 25 modifier to the E/M code.
Ultimately you may have to fight the battle, but if Medicare changes the CPT guidelines on that section then I guess other insurances will follow suit.