Forum - Questions & Answers

Sep 29th, 2021 - sbt

EKG and Spirometry with E&M same DOS

I'd like a suggestion to bill Medicare for an EKG (93000) and Spirometry (94010) with E&M code 99213, same date of service.  I successfully bill E&M with a modifier for one or the other, but not both.  I don't think appending modifier 59 to one of the test codes will work, but I'm not sure.

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Oct 12th, 2021 - ChrisW   206  1 

re: EKG and Spirometry with E&M same DOS

When using the NCCI Edits Validator you will see It is improper to bill 99213 and 94010. However, you may be able to override the edit with a CCI modifier if applicable using modifier 25- Significant Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service.  In addition, a single unit of service using 94010 includes all the necessary spirometric determinations. There are no edits when billing 93000 and 94010. You can also refer to the NCCI Policy Manual for Medicare services.

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