When a new pt establish care and is having and ekg done for their welcome to medicare physical, do I split the ekg coding and bill a portion to Medicare A and then the other half to Medicare B. And if so do we use the "G" codes to do so
Both services get billed to MCR Part B if performed in the physician's office. CMS Preventative Services Quick Reference Information has an easy read chart at: http://www.cms.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf
Bill G0402 for the Exam, and either G0403, G0404 or G0405 for the EKG depending on which portion of the service your doc performed.
I have to edit my previous comment. Right after I posted this, I sat in on a CMS National Provider Call. We were instructed (as an FQHC) to code/bill an EKG as part of the IPPE visit with codes --
G0403 as a screening for the IPPE with interpretation and report;
G0404 as a screening for the IPPE, tracing only without interpretation and report;
G0405 as a screening for the IPPE, interpretation and report only
The IPPE (G0402) is a one-time benefit that must be provided within 12 months of the effective date of a beneficiary's Medicare Part B coverate. The screening EKG (G0403, G0404, G0405), when done as a referral from an IPPE, is also only covered once during a beneficiary's lifetime. Effective dates of serive on or after January 1, 2011, the coinsurance or copayment or deductible ware waived for the IPPE -- ONLY. However, the deductible and coinsurance still applies to the screening EKG.
I work in a large primary care clinic and we have had problems getting Medicare to pay for EKG as part of the Welcome to Medicare CPE. We are only getting paid if the DX is within the LCD/NCD guidelines (always a sick code). Is anyone getting Medicare to pay EKGs for preventative or screening reasons? If so, what code are you billing. This info would be greatly appreciated