ED Coding and Reimbursement Alert

To gain proper reimbursement for EKG and X-ray interpretations, you'll need to separate coding "folklore" from coding fact. These two myths represent common misconceptions: Myth #1: I should bill EKG interpretations for ED physicians cautiously, if at all, since they're not technically qualified to read the tests. Don't let an official qualification hold you back from coding medically necessary and reimbursable services rendered in the ED. The ED physician doesn't need a cardiologist's reading to make medically viable decisions. As opposed to the past, most EDs now have board-certified emergency medicine physicians or permanent emergency physicians, experienced specifically in emergency medicine, and they read EKGs "very well," says Robert LaFleur, MD, FACEP, president of Medical Management Specialists in Grand Rapid, Mich. Myth #2: I shouldn't bill interpretations because the work is included in the E/M Code. If you include the work done interpreting EKG and x-rays under the E/M code, you lose out on reimbursement for work done as a distinct service that requires special skill, La Fleur says. What's included in the E/M guidelines is the ordering of tests.

You can code separately for the EKG interpretation if you provide documentation that the ED physician reviewed it. The CPT manual states, "The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M service."