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Q&A Diagnostic Arrhythmia and Device MonitoringQ1: Should the order be for each individual device check or can it be for the lifetime of the checking of the device? A: The order may be in the form of a protocol signed by the provider – it is recommended that the provider review and sign the order annually by most payers.Q2: What is the standard protocol to perform an EKG before the provider visit?A: An EKG is considered a diagnostic test, which requires an order, medical necessity, etc. Most clinics have parameters for obtaining EKGs in clinic. It would not be recommended that all patients receive an EKG for every encounter. Q3: For Zio billing 0296T & 0298T, is the hook-up date or the interp and report date used for the Dos for billing?A: We recommend checking with your local carrier’s on how they want the date reported as it varies across the country.Q4: Is it correct that an EKG performed on the same date as a PM or ICD check must have separate dx or it will not be billable or payable?A: It would have to support medical necessity outside of the device check in order for the service to be billed. You need to have clear medical necessity to perform an EKG the same day as a device check. Normally it would be a different diagnosis.Q5: for the global code where tc and 26 mod are all in one code - a physician needs to be in suite at all times?A: Direct supervision is required (verify CPT codes with Fee schedule supervision requirements) if the technical component for all in person cardiac device evaluations when performed with an office POS Q6: What modifer do we use if we are doing both an ECG and a procedure?A: Need to verify NCCI edits and payer specific requirements, but normally a 59.Q7: Just looking for clarification, for remote interrogation, for the date of service for technical (93296) would this be the date of download and for 93294/93295 the date of service should be the date the physician does a report and signs report.A: There is an ongoing debate regarding this issue. CMS issued the MLN and ultimately have responded to FAQs with it is based on the AMA CPT description of the particular device, service, etc. Payers also have varying guidance. For remote monitoring the most common practice is to report the download and interp on the same date due to the nature of the monitoring period. This does however vary across practice.Q8: For the pre & post peri-procedural evaluation, our docs use them frequently before and after they perform a cardioversion. This is a scenario where they can utilize these correct?Q9: When device is turned off and then turned back on before/after ablation can we bill periprocedure codes? We cannot get them paid even with modifierA to both: We recommend checking NCCI edits and carrier specific policies. This is more than likely inclusive. The intent of the code is the scenario of an EP going to the OR to turn the device on/off for a surgeon performing a procedure - the reimbursement is for his time and services in this instance. If he is performing the procedure may not be considered separate.Q10: Can you clarify when you would use Z95.0 vs Z45.018. Z45.018 is for programming and Z95.0 for interrogation? Regardless of arrhythmias foundA: You would use one of the Z codes if no abnormal findings are documented by the provider in the interpretation of the report. Z95.0 is used for an interrogation (in-person or remote) and Z45.018 would be used for a programming evaluation service. Q11: Does the billing need to reflect the provider providing the direct supervision, for instance different provider reads the interpretation as opposed to the provider in office who providing the direct supervisionA: Yes, if different providers are involved, then you would report the service with the TC modifier for the provider who supported the direct supervision and the 26 modifier for the interpreting provider. We recommend this be documented with in the report if the providers are different. Q12: Have you seen cpt codes 93284 and 93290 being denied as inclusive? Insurance companies are saying cpt 93290 is inclusive with cpt 93284. A: Medicare did have an NCCI edit at the beginning of 2020. They have since corrected the edit. We recommend checking directly with your payers to see if they are allowing these services to be reported together. ................
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