Revenue Cycle Insider

Question: After a patient undergoes cardiac surgery and is discharged, the cardiologist performs a postoperative electrocardiogram (ECG) interpretation a few days later and bills 93010. Does this service require a modifier when submitted on a claim by the interpreting provider?

California Subscriber

Answer: You should use 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) for the professional component of a routine 12-lead ECG interpretation and report when the provider reviews an already performed ECG and generates a formal report.

Notice how the code descriptor reads “interpretation and report only.” Because 93010 itself represents only the interpretation and report, it already reflects the professional component and does not require modifier 26 (Professional component) or TC (Technical component). Those modifiers apply to codes that split professional and technical components, but 93010 is expressly the interpretation code.

However, you might need a different modifier, such as 59 (Distinct procedural service). Whether you need a modifier when billing 93010 after a surgery depends on payer rules and the clinical context:

• If the interpretation is medically necessary and distinct from any bundled service included in the surgical global period or another encounter, you may not need a special modifier just for it; documentation must clearly support medical necessity.

• Some payers require a modifier indicating a distinct service (such as modifier 59 or other appropriate distinct procedural modifiers) when reporting 93010 unrelated to the surgery or other services on the same date to differentiate it from bundled or integral parts of other services. Check specific payer guidelines to confirm if 93010 requires a modifier for separate reimbursement. 

• You might use modifiers 76 (Repeat procedure or service by same physician or other qualified health care professional) or 77 (Repeat procedure by another physician or other qualified health care professional) when the same ECG interpretation is repeated on the same day by the same or different provider, respectively, which wouldn’t generally apply to a postoperative interpretation on a subsequent date. 

In summary, you do not automatically append modifier 26 or modifier TC to 93010 because it already denotes the professional interpretation component, but you should verify payer-specific modifier requirements for distinct services (such as modifier 59 when necessary to indicate an unrelated evaluation). Make sure you have documentation to support separate reimbursement.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor