Know When to Roll ECG Interpretation Into E/M
Question: The emergency department (ED) physician orders an electrocardiogram (ECG) for a patient having chest pain. The ED has an on-site cardiologist perform and interpret the ECG, so I know that they will be reporting an ECG CPT® code. Our physician did, however, make the decision to order the ECG and offer their input on the cardiologist’s interpretation. The final diagnosis is angina pectoris. How can we capture the ED physician’s work on the ECG? Can we report an ECG code as well? Texas Subscriber Answer: There are situations in which the ED physician can report an ECG code, but this isn’t one of them. Payers will only reimburse a single provider on ECG codes. Your doctor’s ECG work will figure into the equation when you decide the level of medical decision making (MDM) for the visit — provided, of course, the doctor properly documents their ECG-related actions in the record. Specifically, you can give the ED physician credit under the “Amount and/or Complexity of Data to Be Reviewed and Analyzed” column in the MDM table of CPT® 2026. Do this: Go back and check the notes, being careful to include the ED physician’s documented ECG work in the MDM calculation. Then choose a code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set for the ED physician’s services. Don’t forget: Append I20.9 (Angina pectoris, unspecified) to the ED E/M code to represent the patient’s angina pectoris. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
