Per New CMS Transmittal Modifier, All Claims With Modifier GZ Will Be Denied Immediately

As per the latest CMS regulation, all claims with modifier GZ appended will be denied straight away. It is not unusual even in the best-run medical practices that the physician performs a noncovered service and doesn’t get an ABN signed. If you shoul...

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Correct Coding Initiative: 93025 Guidelines Now Coincide With 16.2 Edit Deletions

The National Correct Coding Initiative (CCI) version 16.3 instructions align MTWA and stress tests coding manual guidelines with version 16.2 edit deletions.

Update Chapter 11 of Your CCI Manual

The CCI version effective July 1 deleted the edits that barred reporting cardiovascular stress test codes 93015-93017 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress …) with MTWA code 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias).

The manual in effect at that time, however, stated you couldn’t report 93015-93017 on the same date as 93025. The previous wording said, “If a physician performs an MTWA with submaximal stress test followed by a traditional stress test on the same date of service, CMS payment policy allows separate payment of MTWA (CPT code 93025) and the interpretation and report for the traditional stress test (CPT code 93018). The practice  expense component of the traditional stress test is not separately payable, and a physician should not report CPT codes 93015-93017 on the same date of service as CPT code 93025.”

CCI’s updates present in the current manual, version 16.3, reflect the CCI edit deletion that allows you to report both an MTWA with submaximal stress test and a traditional stress test, acknowledging that the tests are different. The current wording says, “Microvolt T-wave alternans (MTWA) (CPT code 93025) testing requires a submaximal stress test that differs from the traditional exercise stress test (CPT codes 93015-93018) which utilizes a standard exercise protocol. CPT codes 93015-93018 should not be reported separately for the submaximal stress test integral to MTWA testing. If a physician performs an MTWA with submaximal stress test followed by a period of rest and then a traditional stress test on the same date of service, both the MTWA and traditional...

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