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EKG Coding Conundrums

EKG Coding Conundrums

The rules for coding EKGs may change depending on the treatment scenario.

Patients who report to the emergency department (ED) for an electrocardiogram (EKG or ECG) can create a coding quandary. Namely, how does the ED coder report their physician’s work with the patient? Can they use the EKG CPT® codes or do they need to go another route?

The answer is … it depends. Your coding in these situations is scenario-dependent, so you need to be ready to code a couple of different ways depending on encounter specifics.

We rounded up some experts to see what they had to say about which codes you should use in which situations to correctly code EKG patients each time.

Remember These Codes and This Modifier

If a patient reports to the ED and receives an EKG, there are two code categories you should focus on:

  • ED evaluation and management (E/M) codes 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional through 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
  • EKG codes 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, 93005 … tracing only, without interpretation and report, and 93010 … interpretation and report only

Regardless of the situation surrounding the encounter, these are the codes you should focus on for EKG coding.

Do This if a Cardiologist Interprets the EKG

When your ED physician orders an EKG, a lot will depend on the other physicians on the clock at the hospital — specifically cardiologists.

“Usually in the ED setting, hospitals will have contracts with a cardiologist to perform the official interpretation for the EKGs and allow them to bill for the interpretation,” explains Rae Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CCS, AAPC Approved Instructor, chief product officer at AAPC and member of the CPT® Editorial Panel. “Insurance will only cover one interpretation for an EKG.”

So, when the facility’s cardiologist performs (and bills for) the EKG interpretation, “ED physicians will usually include the work of the interpretation they perform in the MDM [medical decision making] since they can’t bill for it separately,” confirms Jimenez.

If an ED physician orders an EKG in their workup of a patient, they can get credit for it under the “Amount and/or Complexity of Data to Be Reviewed and Analyzed” column in the MDM table, explains Jill Young, CPC, CEDC, CIMC, owner of Young Medical Consulting in East Lansing, Michigan. ED physicians, however, “do not get any [MDM] credit for analyzing a test they ordered.”

There is also another way the ED physician could get MDM credit for an EKG. If a different provider ordered the EKG and the ED physician is analyzing it as part of their workup, “they can take credit under amount and complexity of data but need to show how they used it,” explains Young.

When your ED physician does perform an “independent interpretation of test,” the claim must be accompanied by a detailed report to get credit in the MDM table, Young warns. Check your payer contracts to see just how detailed each one wants this report.

Do This if an ED Physician Interprets the EKG

Not every ED will have a cardiologist available to interpret EKGs; CPT® has a solution for coding under this scenario. “If the hospital does not have an arrangement with a cardiologist to interpret the EKGs, then the ED physician can perform and bill the CPT® code for the interpretation,” confirms Jimenez.

If the ED physician bills the CPT® code for the interpretation, then they can’t count that work in the MDM data element for the order or the performance of the interpretation, reminds Hamilton Lempert, MD, FACEP, CEDC, vice president of coding policy at TeamHealth.

Potential problem: If the ED physician performs an EKG interpretation and you code for it, getting paid might be tough. In an ED encounter, there is nearly a 100 percent chance of an ED E/M occurring; many times, that ED E/M code cannot be paired with an EKG code.

“Many insurance companies will not allow an EKG to be billed along with an ED E/M code. There is no justification for this practice, but they still do it,” relays Lempert.

Best bet: Know your payer’s policies on reporting an ED E/M service and EKG on the same claim and code accordingly. Different payers have different rules, so check your contracts to see what each payer has to say about this clinical situation.

Chris Boucher
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About Has 12 Posts

Chris Boucher, MS, CPC, has nearly 20 years of experience writing and editing for coding and compliance. He covers several subjects for AAPC, including CPT® coding, modifiers, HIPAA compliance, and ICD-10 coding.

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