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Do not use 93040-93042 to report review of telemetry strips.

Electrocardiogram (ECG/EKG) coding seems straightforward — until you’re knee-deep in modifiers, lead counts, documentation gaps, and bundling issues.

This guide debunks five common ECG coding myths and gives you a clear view of what you should and shouldn’t do when coding both routine and rhythm ECGs.

Myth 1: EKG and ECG Are Different Tests

Reality: They are the same test:

• ECG = Electrocardiogram (English abbreviation)
• EKG = Elektrokardiogramm (German-derived term)

These terms can be used interchangeably. The test records the heart’s electrical activity, typically using leads attached to the skin.

Myth 2: All ECGs Use the Same CPT^® Code

Reality: The number of leads and components performed determine which CPT^® code to use.

For 12-lead (routine) ECGs, report:

• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) for global, which includes tracing and interpretation/report
• 93005 (… tracing only, without interpretation and report) for technical only, which includes tracing without interpretation
• 93010 (… interpretation and report only) for professional only, which includes interpretation and report

You’ll use 93000 when the cardiologist owns the equipment and does both the tracing and interpretation. Use 93005 and 93010 when the services are split between facility and physician.

For one to three lead (rhythm) ECGs, report:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) for global
• 93041 (… tracing only without interpretation and report) for technical only
• 93042 (… interpretation and report only) for professional only

Rhythm ECGs are used to evaluate arrhythmias and monitor the heart rhythm, not to provide a full cardiac assessment.

Myth 3: Any Provider Review Qualifies as an Interpretation

Reality: A valid interpretation must include:

• A separate, signed, and retrievable report; and
• Documented findings, clinical relevance, and comparative data, if applicable.

Pitfall to avoid: Phrases like “ECG normal” do not meet Medicare’s documentation requirements for interpretation and report.

Myth 4: Rhythm ECGs Are Free-Form Services

Reality: CPT^® outlines specific rules that must be followed for rhythm ECGs (93040-93042):

Follow these rhythm ECG rules:

1. There must be a specific physician order.
2. The order should be triggered by a sign, symptom, or clinical concern.
3. The ECG must be used to evaluate an arrhythmia.
4. The provider must complete a signed, written, and retrievable interpretation/report.
5. Documentation must support medical necessity for performing the test.

Pitfall to avoid: Do not use 93040-93042 to report review of telemetry strips. These are part of continuous monitoring, not standalone ECGs.

Myth 5: ECGs Can Always Be Billed Separately

Reality: Certain services bundle ECGs and prohibit separate reporting.

Do not report 93040-93042 with the following codes:

• 93260 (Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system)
• 93279-93289 (Programming device evaluation …)
• 93261, 93291-93296, or 93298 (Interrogation device evaluation …)

Also: Do not bill separately for ECGs performed as part of:

• Stress tests
• Stress echocardiograms
• Annual wellness visits
• Welcome to Medicare appointments

Best practice: Review documentation carefully to confirm that the ECG was performed at a separate session and meets medical necessity before billing independently.

Final Advice for Coders

Accurate ECG coding comes down to:

• Understanding the type of ECG performed (rhythm vs. routine)
• Knowing what’s included in each CPT^® code
• Ensuring documentation fully supports the service
• Avoiding unbundling and compliance traps

If you’re ever unsure, consult payer policies, Medicare guidelines, or the CPT^® code book before submitting the claim.

Suzanne Burmeister, BA, MPhil, Medical Writer and Editor