ED Coding and Reimbursement Alert

Specificity and razor-sharp record keeping hold the key Emergency department physicians perform diagnostic electrocardiography (ECG) tests every day, but whether you earn reimbursement for them depends on establishing credible medical necessity - and that means choosing the correct diagnosis code.
 
You can describe these services with one of three codes: 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), 93005 (... tracing only, without interpretation and report), and 93010 (... interpretation and report only). Since the ED physicians don't own the equipment they're using, you'll report 93010 most often.
 
During the noninvasive procedure, the physician places electrodes on the patient's chest, arms and legs to produce an electrical recording of the heart. Technically speaking, the ECG is a graphic tracing of the electrical activity caused by the impulses that travel through the heart that determine the heart's rate and rhythm as detected at the body surface.
 
In order to show medical necessity for the ECG, you need to choose an ICD-9 code that tells the payer exactly why the ED physician needed to perform the service. Increasingly, carriers are denying payment if the ICD-9 codes are not specific enough. The physician's diagnosis must justify the interpretive test, such as an ECG, says Tamra McLain, CPC, coding manager for HRA Medical Management Inc. in the San Diego area.
 
Ensure you're coding to the highest possible level of specificity by following this airtight coding and assessment process:
 
1. Gather complete information. When you are translating the physician's documentation into codes, you need complete information - and you may not have enough to code the services based on her written notes.
 
For example, if the doctor writes "heart failure" in the patient's record, you should ask for more details. Heart failure (428.x) is an incomplete (truncated) code, and if you don't carry it out to the highest degree of specificity, your carrier is likely to deny the claim. You need the data that will help you determine the type of heart failure.
 
Congestive heart failure, unspecified (428.0), for example, is a more specific code that will allow the carrier to pay you for the ECG. Keep in mind that a rule-out diagnosis may be clinically important to have in the chart, but it will not justify the procedure or service from the insurer's perspective, and you shouldn't code it directly. In such a case, you'll have to seek out more information on the specific symptoms from the patient's chart or by asking the physician.
 
And, due to the nature of the clinical interaction in the ED, carriers accept symptom-based diagnosis codes. Codes such as unspecified chest pain (786.50) or shortness of breath (786.05) may be all the clinical information available during the physician's initial [...]