Cardiology Coding Alert

Warning: You won't be paid for G0366 and G0367 in a facility setting

When your cardiologist checks a Medicare patient for heart disease and performs a one-time "Welcome-to- Medicare" ECG, you'll have to abide by National Correct Coding Initiative version 11.1 rules or else you'll have a denial.

Within six months of enrollment in Medicare, patients qualify for a one-time head-to-toe screening physical exam and screening ECG.

One-time only: In the event of this kind of screening visit, instead of flipping to a traditional ECG code, such as 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), you'll need to use one of the following new G codes, as of April 1, 2005:
   G0366 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the initial preventive    physical examination. (Note: This code is identical to 93000.) A physician or qualified nonphysician who performs the complete ECG service, in addition to the physical, would report both G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and G0366, according to the Nov. 15, 2004, Federal Register.   G0367 - ... tracing only, without interpretation and report, performed as a component of the initial preventive physical examination. (Note: This code is identical to 93005.)
  G0368 - ... interpretation and report only, performed as a component of the initial preventive physical examination. (Note: This code is identical to 93010.) Remember: Medicare won't pay for G0366 and G0367 when the physician performs the services in the facility setting, the Register states. The reason is these two codes include the technical component of the test. In a facility setting, you should not report the technical component of the service, just the professional component (G0368).

NCCI also applies edits to the following traditional ECG codes, which prevent you from reporting a diagnostic ECG performed to assess symptoms/signs along with the one-time screening ECG:  93005 - Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
  93010 - ... interpretation and report only
  93040 - Rhythm ECG, one to three leads; with interpretation and report
  93041 - ...tracing only without interpretation and report
  93042 - ... interpretation and report only. Note: These edits are listed as mutually exclusive procedures, which means that practitioners cannot reasonably perform these procedures together. These edits have a modifier indicator of "1" which means you're permitted to use a modifier to bypass the bundle. But keep in mind that you must meet the criteria of modifier -59 (Distinct procedural service), says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. Otherwise you cannot separate the services. In other words, you should use modifier -59 only for [...]