tci Medicare Compliance & Reimbursement - 2013 Issue 14

Reader Question: CMS Will Immediately Deny Outdated Codes

Question: A 65-year-old patient who just enrolled in Medicare came to our office for his IPPE. I billed G0402 with G0366. Medicare denied the claim with a status code of 507 (HCPCS). Is there some reason why we should not be able to use G0402? Answer: Your claim probably is being denied because G0366 (Electrocardiogram, routine EKG with 12 leads; performed as a component of the initial preventive examination with interpretation and report) was deleted in December 2008 and should not be reported. Instead, you should report G0403 (Electrocardiogram, routine ECG with 12 leads; performed as a screening for...

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