ED Coding and Reimbursement Alert

The most effective way to code EKG and x-ray interpretations for the emergency physician requires more than just deciphering rules it takes speed. Down in the coding trenches, you're less concerned with political crossfire than with clearing claims for reimbursement. Here are tips for coding and billing EKG and x-ray interpretations by the ED physician, despite the current policy controversy. You must have documentation of a "contemporaneous" interpretation to trigger Medicare payment for the professional interpretation of an EKG and x-ray rendered by the ED physician. In other words, you should expect payment if documentation indicates that the physician's reading made a timely and direct contribution to the diagnosis and treatment of the patient. An interpretation provided "days or hours" after the patient goes home does not fit CMS' requirement that the interpretation be performed "contemporaneously" with the diagnosis and procedure, according to a letter sent by Paula C. Ohliger at Foley & Lardner attorneys (San Francisco) to the associate executive director of policy at the American College of Emergency Physicians.

As with all claims, you have to show medical necessity. The physician's diagnosis must justify the interpretive test, such as an EKG, says Tamra McLain, CPC, coding manager for HRA Medical Management Inc. in the San Diego area. For a list of Medicare's diagnosis codes, check with your local carrier or go to www.lmrp.net. Plow Ahead, If You Have the Documentation Submit the interpretation claims if they contributed directly to the diagnosis and treatment of the patient, even if your specialist might bill for the same reading you've reported.

Even though CMS states that it will deny your claim and pay the specialist's contemporaneous interpretation, don't throw in the towel. Under many circumstances, the ED is allowed to receive payment for interpretive services, says James Blakeman, senior vice president of Healthcare Business Resources in Bala Cynwyd, Pa.

You forfeit payment if you assume the radiologist and cardiologist automatically receive payment for interpretations. If a cardiologist interprets an EKG seven days after the patient leaves the ED, and the emergency physician provided the EKG interpretation that helped with diagnosing and treating the patient, then the ED physician's claim not the specialist's qualifies for payment.

You must follow payers' official policies for billing ED interpretations, but if you add these practical hints to your repertoire, you're more likely to see results: Get to the line first, lest you be disqualified. Interpretation payments go to the swiftest, so get your claims in on time. The sooner they cross the payer's line, the more chance they have of passing the "truly contemporaneous" criterion. Your timely claim tells the payer or carrier: Only the interpretation given in time for a patient's diagnosis in the [...]