Forum - Questions & Answers

Jan 31st, 2013 - vsmichael 20 

EKG's and Annual Physicals

Historically, our office has always performed an EKG and a U/A as part of a patient's Annual Physical. The claim would look like this:
V70.0 for the Preventive visit with both the EKG and U/A linked to the V code.

We have begun seeing denials from some of our commercial payers on the EKG. One of the payers stated "service not covered under benefit plan" with the liability on the patient. Another payer denied stating, "this is a non-covered service." When I called the payer I was told that their plan follows the USPSTF recommendations that routine EKG's are not considered "preventive". Our physician is insistent that EKG's need to be done at the physical. Any suggestions on how to handle this? Has anyone else out there encountered this issue and how did your office handle this? Any assistance is appreciated!

Jan 31st, 2013 - bsergi 110 

re: EKG's and Annual Physicals

I believe if you reference a CPT® book and ekg is not preventive. Maybe, it would pay if you did not use routine/preventive diags, but then the patient would get hit with a copay.

Jan 31st, 2013 -

re: EKG's and Annual Physicals

It really depends on the patient's plan whether or not it will be covered, but here are some options

1. Have the patient sign an ABN stating the insurance will not pay because of medical neccesity.

2. Submit with Cardio screening code V81.2 ... Some commercial insurance WILL pay for this.

3. Submit with a diagnostic code, IF the patient is showing signs/symptoms. View the LCD for EKGs. There are many payable Dx's.

Jan 31st, 2013 -

re: EKG's and Annual Physicals

Just to add the medical side of things...the data is clear that there is no benefit to routine EKG's for the "well person" being seen for a annual physical. That does not include those with a chronic stable illness such as diabetes or hypertension who may benefit from one. Of course if you link the EKG to the disease (250.00) then it is not preventative and may affect patient liability.

Feb 4th, 2013 - vsmichael 20 

re: EKG's and Annual Physicals

Thanks signaturedoc! I appreciate your feedback and you are exactly right!!!

Feb 4th, 2013 - vsmichael 20 

re: EKG's and Annual Physicals

Thank you michellediane! I appreciate your follow-up!

Feb 4th, 2013 - vsmichael 20 

re: EKG's and Annual Physicals

Thanks bsergi! Your follow-up is greatly appreciated!



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