Cardiology Coding Alert

Make sure the documentation supports medical necessity for the rhythm strip.

Reporting EKGs (electrocardiogram) can be tricky. You must know if the cardiologist performed a telemetry monitoring service versus an actual rhythm service. You must also understand and follow CPT®’s specific criteria for EKGs. Additionally, your medical documentation must be in tip-top shape.

Check out the following tips to ensure your rhythm services always make the grade.

Tip 1: Report 93040-93042 for Rhythm EKGs Only

You should report rhythm EKGs, which have no more than three leads, with the following codes:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report)
• 93041 (...; tracing only without interpretation and report)
• 93042 (..., 1-3 leads; interpretation and report only).

Caution: There is a difference between telemetry, continuous monitoring, and a rhythm strip, typically a single, limited, one lead tracing for a limited period of time. It is inappropriate to report codes 93040-93042 for reviewing the telemetry monitor strips taken from a monitoring system, according to the CPT^® guidelines. The cardiologist’s review of the telemetry data is considered part of the associated evaluation and management (E/M) service.

Instead, you would correctly report a code like 93042 for an EKG with a specific order related to a patient’s specific set of symptoms or conditions.

Tip 2: Meet These Specific Criteria

If you report rhythm EKG codes 93040-93042, you must meet the following criteria, according to CPT®:

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

Coding example: The cardiologist performs both the professional and technical components of the patient’s one-lead rhythm EKG. The cardiologist’s required, specific order for the EKG supports the patient’s diagnosis of R07.9 (Chest pain, unspecified) as the triggering event. The cardiologist uses the rhythm strip to help diagnose the presence of absence of the arrhythmia. The medical documentation demonstrates the need for the cardiologist to evaluate the patience presence or absence of an arrhythmia. A separate signed, written, and retrievable report follows the EKG order. The cardiologist owns both the EKG machine and the supplies. Based on these details, you can report 93042 for this service, with no modifiers appended.

Tip: Lack of documentation can be a hotspot to avoid when billing codes 93040-93042.

A likely culprit for these type of denials can be that “the billed date of service does not match the documented date of service,” explains Marcella Bucknam, CPC, CCS-P, COC, CCS, CPC-P, CPC-I, CCC, COBGC, revenue cycle analyst with Klickitat Valley Health in Goldendale, Washington. “This can be challenging if interpretations are performed on a different date from the date the study was performed. There needs to be clear documentation of the date that the physician did his interpretation.”

Tip 3: Grasp Exactly Which Service Physician Performed

When it comes to reporting codes 93040-93042, you must understand what service the physician performed by looking at the documentation.

Rule for 93040: You should report 93040 for both the professional and technical components of the rhythm EKG service, says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee. The physician must own the machine and supplies to report this code. Also, since code 93040 represents both the technical and professional components of the EKG service, you should not append modifiers 26 (Professional component) or TC (Technical component).

Rule for 93041: You should report 93041 to capture the technical component only of a rhythm EKG service.

Rule for 93042: You should report 93042 to capture the professional component only of the rhythm EKG service, Neighbors adds.

Remember: There must be a diagnostic sign and symptom purpose to support reporting these additional procedures, Neighbors explains. A standard protocol follow-up EKG is included within the primary procedures the cardiologist performs.

A pre-procedure EKG is included within the primary procedure unless it’s the initial EKG that determined the definitive diagnosis, Neighbors adds. If this EKG is only performed to identify a patient’s rhythm before sedation, it’s included within the primary procedure.