Cardiology Coding Alert


Answer 5 Common ECG Coding Questions

Hint: Follow specific rules for rhythm ECGs.

Reporting electrocardiograms (ECGs) can be tricky. You have to know the difference between rhythm and routine ECGs. You also must know what services you cannot report in conjunction with the ECG codes.

Read on to learn more.

Understand What EKG, ECG Is

FAQ 1: Is there a difference between an EKG and an ECG?

Answer: No. ECGs and EKGs are two abbreviations for the same procedure — an electrocardiogram. An electrocardiogram is the recording of electrical activities of the heart and their interpretation by a physician.

In the heart, the Sinoatrial (SA) Node, located in the right atrium, sends electrical impulses to the heart’s muscles, which contract, resulting in systole. If the cardiologist performs a twelve-lead ECG, for example, they use twelve electrodes placed on the skin over different regions of the patient’s body (the limbs and chest). These electrodes then record the heart’s electrical activities, and the recordings are put into a graphic format.

12-lead ECG: A 12-lead ECG provides a complete 3-dimensional look at the heart’s electrical activity. With a 12-lead ECG, a cardiologist can identify conditions like myocardial ischemia and myocardial infarction and also get a picture of any arrhythmia that might be happening.

1-3 lead ECG: The cardiologist can also perform a 1-3 lead ECG, which is also known as a rhythm ECG. Rhythm ECGs focus on the patient’s heart rhythm and are useful for 

identifying heart block and tachyarrhythmias. Rhythm ECGs have no more than three leads.

Focus on Routine ECG Code Options

FAQ 2: Which codes should I report for routine ECGs with at least 12 leads?

Answer: If your cardiologist performs a routine ECG with at least 12 leads, report the following codes:

  • 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpre­tation and report). Note: Use code 93000 when your cardiologist performs an ECG in his office. In this case, the cardiologist owns the ECG machine and performs the interpretation and report.
  • 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report). Note: A facility reports code 93005 when it provides an ECG for a patient. The ECG machine and tracings are considered the technical component of the 93005 service.
  • 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). Note: Report 93010 if your cardiologist performs only the interpre­tation and report of an ECG in a facility. In this case, 93010 is the professional component of the ECG, and since the facility owns the ECG machine and tracing, your cardiologist would only report the professional component.

Codes 93000-93010 are reported for electrocardiograms with 12 leads to record the electrical activity of the heart, normally while the patient is in a lying down or prone position, says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Pinpoint These Codes for Rhythm ECGs

FAQ 3: Which codes should I report for rhythm ECGs?

Answer: If your cardiologist performs a rhythm ECG, report the following codes:

  • 93040 (Rhythm ECG, 1-3 leads; with interpretation and report). Note: Report code 93040 for both the professional and technical components of a rhythm ECG service. In this case, your cardiologist must own the machine and supplies if you report this code.
  • 93041 (...; tracing only without interpretation and report). Note: Report code 93041 to capture the technical component only of a rhythm ECG service.
  • 93042 (..., 1-3 leads; interpretation and report only). Note: Report 93042 captures the professional component only of the rhythm ECG service.

With 93040-93042, three leads are used, and the patient is monitored over a specified period of time to get a reading of the heart’s currents while the patient is active, Johnson says.

“An interpretation and report are significantly different than a review of findings. CPT® does not clearly state a documentation standard. However, Medicare guidelines indicate ‘there must be a separate, signed, and written retrievable report.’ Medicare guidelines say an interpretation and report, ‘should address findings, relevant if clinical issues, and comparative data when available.’ Documentation such as “ECG normal” is considered insufficient documentation,” says Amy Pritchett, AAPC Fellow, CCS, CRC, CPA-RA, CPC, CPMA, CPCO, CDEI, CDEO, CDEC, CANPC, CASCC, AAPC Approved Instructor Manager of HCC Coding-Audit and Educational Services, Pinnacle Enterprise Risk Consulting Services, LLC.

Follow Handy Rules When Reporting Rhythm ECGs

FAQ 4: Do you have a list of rules to follow when reporting rhythm ECGs?

Answer: CPT® gives you these specific rules when reporting rhythm ECGs:

  • Rule 1: There must be a specific order for the ECG or rhythm strip.
  • Rule 2: The order for the exam must have been triggered by an event, like a sign or symptom.
  • Rule 3: The provider uses the rhythm strip to help diagnose the presence or absence of an arrhythmia.
  • Rule 4: A separate signed, written, and retrievable report must follow the ECG order.
  • Rule 5: The documentation in the patient’s medical record should support the medical necessity for the ECG or rhythm strip.

Caution: Never report codes 93040-93042 for the review of telemetry monitor strips taken from a monitoring system, per CPT®.

Don’t Report These Codes Together

FAQ 5: What services cannot be reported with 93040-93042?

Answer: CPT® instructs you not to report 93040-93042 with programming device evaluation codes 93260 and 93279-93289, or with interrogation device evaluation (evaluation of implantable devices such as cardiac pacemakers or implantable defibrillators) codes 93261, 93291-93296, or 93298.

“EKGs are considered part of certain diagnostic studies such as stress tests and stress echocardiograms, so be careful to review the documentation to make sure the EKG was performed at a separate session from these types of diagnostic studies and that they are medically necessary,” Pritchett says. “Also, standard EKGs are part of an annual wellness visit and welcome to Medicare appointments.”