Cardiology Coding Alert

Reader Question:

Getting Paid for Stress Test and an EKG

Question: Why are insurance companies bundling EKGs with stress tests? Yet if we request a letter stating they will be responsible for any outcomes due to not taking EKG prior to a stress test, they will pay.

Jan Seda, RN, BS, Coder
The Mid-Columbia Heart Institute, Richland, WA

Answer: An EKG is payable if it is done as a diagnostic tool before performing the stress test. For example, to be certain of the diagnosis of coronary artery disease, the cardiologist relies on the patients history, an EKG, and symptoms of chest pain.

However, some physicians have inappropriately billed for EKGs during the stress test and in that case, the service is bundled. To properly indicate an EKG performed prior to a stress test as a diagnostic procedure, append modifier -59 (distinct procedural service) to the EKG.