Staying Independent...Together

Print Message

   Coding help
 From: Mamatha Agrawal
 To: Member Forum
 Posted: 11-18-2017 13:23
 Message: This Medicare claim keeps getting rejected.
I did a visit, pre-op EKG and a biopsy on the face which turned out to be basal cell on the pathology.

The visit is 99214-25 (E11.65 uncontrolled diabetes, M48.061 lumbar spinal stenosis)
11311 (procedure on face and coded as C44.319 basal call on face) I tried this without modifier 51 and then added modifier 51.
93000 EKG (tried coding as pre-op exam, then as abnormal EKG)

Any thoughts? I don't mind just sacrificing the pre-op EKG. Does the mole have to be coded nevus uncertain nature?
Generally do they pay for EKGs that are just for pre-op for Medicare patients?

The rejection note said " PER CCI GUIDELINES PROCEDURE CODE 93000 HAS AN UNBUNDLE RELATIONSHIP WITH PROCEDURE CODE 11311 BILLED FOR THE SAME DATE OF SERVICE. REVIEW DOCUMENTATION TO DETERMINE IF A MODIFIER OVERRIDE IS APPROPRIATE."

THANKS!

------------------------------
Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
------------------------------

Copyright 2016 Ideal Medical Practices. All rights reserved.