billing 93005 (EKG) with surgical cpt

lwoodworth@hcmc-tn.org

I'm not sure if this is the correct list serv to ask this question, but here goes...If a SDS comes in and has the EKG done just prior to the surgery on the same day, is it appropriate to add a modifier to 93005 (EKG) when I get the edit that it is "code two of a code pair"? I have not been adding the modifier to 93005 as an EKG is normally done prior to almost all surgeries. Sometimes patients will come in a day or two before and have the pre-op things done sometimes not. Any insight would be greatly appreciated. thanks

Erica

Hello,

If the EKG is done PRIOR to the surgery for a diagnostic reason and not DURING the procedure for cardiac monitoring, then it would separately reportable. The EKG would need to be medically necessary and not a routine pre-op, at least for Medicare. Medicare does not cover routine pre-ops without the presence of a sign/symptom/condition. I would recommend -XE modifier (separate encounter) for these scenarios.

NCCI Policy Manual, Chapter 1, pg. 15:

"Many procedures require cardiopulmonary monitoring either by the physician performing the procedure or an anesthesia practitioner. Since these services are integral to the procedure, they are not separately reportable. Examples of these services include cardiac monitoring, pulse oximetry, and ventilation management (e.g., 93000-93010, 93040-93042, 94760, 94761, 94770)."

Erica

debra.conard@mymlc.com

The way our facility works these are if the EKG is stat and has an arrhythmia then we add a modifier if it is just routine it is consider part of the OPPS. Hope this helps

lwoodworth@hcmc-tn.org

In the below instance, it was for a routine preop as EKG is one of the items on our "checklist" that has to be completed before they are taken to the OR. For this instance, would you still use a modifier?
Thanks in advance.

Erica

I didn't realize you were billing for the facility. I do physician billing only, however, I would think if it's just routine that it should not be billed separately.

sherry.owens@hcahealthcare.com

Hello,

I bill for the CRNA's here at my facility,,,,I am having an issue of deciding what modifiers to use when I have a patient that has 2 procedures in the OR on the same day...can you advise me any on that?


sherry

lwoodworth@hcmc-tn.org

Thanks so much for everyone's responses. It has been very helpful. I might need to "pick" your brains for something in the future. Good to know I have someone I can bounce things off of.
Thanks again everyone!