tci ED Coding & Reimbursement Alert - 2013 Issue 2

Reader Question: Verify What Is Really Bundled Into Critical Care

Question: We got a denial from an insurance company for an EKG interpretation (93010) that was billed with critical care (99291). Their appeal denial letter said "…the CPT® book states that ECG’s are included in the critical care code. Therefore we will not process any additional payment for these claims." Is this correct? Texas Subscriber Answer: No, it is not. CPT® says the following: "The following services are included in reporting critical care when performed during the critical period by the physician(s) providing critical care: the interpretation of cardiac output measurements (93561, 93562), chest x-rays (71010...

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