Medical Billing Coding - 93015 Denials in NY, cpt, codes
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Thread Topic: 93015 Denials in NY
Topic Originator: Josie Mapp
Post Date April 2, 2008 @ 9:15 AM
93015 Denials in NY

Josie Mapp
April 2, 2008 @ 9:15 AM Reply  |  Email Friend   |  |Print  |  Top

I really need some help with procedure code 93015.  We have an entire report with Medicare denials of this code.  I have researched everywhere and cannot find the clue.  As per Medicare, they are denying it because it is not being submitted properly.  We are including it in a Nuclear (Myoview) test with the following procedure codes:  36000, 78465, 78478, 78480, A9502 & 90774.  It used to get paid all the time until 2007.  We have submitted without modifiers, with the technical & professional components, with the modifier for the scarcity bonus, and NOTHING IS WORKING.  We asked a few colleagues and nothing is working.

Please e-mail or call me at 917-892-7201.  Your response will be appreciated.

April 2, 2008 @ 9:25 AM Reply  |  Email Friend   |  |Print  |  Top

Here is NY Medicare LCD:

Coding Guidelines

   1.  The guidelines of the Correct Coding Initiative (CCI) supersede all
       coding instructions in this LCD.

   2.  The diagnosis code(s) must best describe the patient's condition for
       which the service was performed.

   3.  Use the appropriate code(s) from the series 93015-93018 to report the
       exercise/pharmacological stress service.

   4.  Codes J0152, J1245 and J1250 may be billed in place of service, office
       (11) and independent clinic (49), if the conditions of "incident to"
       are met.

   5.  The administration of the pharmacologic stress agent is included in
       the test and should not be coded separately.

   6.  CPT codes 93350 (global), 93015, 93016, 93017 and 93018 are payable in
       places of service:  office (11) and independent clinic (49).

   7.  CPT codes 93016, 93018, and 9335026 are payable in places of service:
       office (11), inpatient hospital (21), outpatient hospital (22),
       hospital emergency room (23), ambulatory surgical center (24),
       independent diagnostic testing facility (IDTF) (11), and independent
       clinic (49).

   8.  CPT codes 93320TC and 93350TC are payable with general supervision in
       place of service office (11), home (12), assisted living facility
       (13), skilled nursing facility (31), and nursing facility (32) if no
       injections are administered.

   9.  If a significant and separately identifiable E&M service is performed
       by the same physician on the same day of the procedure, then that E&M
       service may be reported with a -25 modifier.

   10. Use code A9700 to report contrast material.  The name of the contrast
       material, the dose administered, the unit price and the total charge
       must be reported in Item 19 of the CMS-1500 form   or in the
       electronic equivalent.

   11. Billed services for which the provider expects a medical necessity
       denial should have either the GA (with signed ABN) or GA (without
       signed ABN) modifier attached to the code. If the statutorily
       non-covered or without benefits category, use the GY modifier instead.

April 9, 2008 @ 2:10 PM Reply  |  Email Friend   |  |Print  |  Top

Do you use 93016 and 93017 along with 93015?

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