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ED Coding and Reimbursement Alert

Reader Question:

Be specific with the diagnosis to show ECG Claim medical necessity

Published on Mon Nov 21, 2011

Question: What codes should we use to report diagnostic electrocardiography (ECG) tests? And how can we prove medical necessity for these tests? We have gotten several recent "medically unnecessary" denials on ECG claims. Minnesota SubscriberAnswer: Emergency physicians often order ECGs based on presenting symptoms to determine whether the patient has a cardiac problem. Payment for this diagnostic test often depends on whether you can prove medical necessity. Choose an ICD-9 code that tells the payer exactly why the emergency physician needed to perform the service. If your diagnosis code is not specific enough, payers may balk at accepting your claim. Start by getting all the information you need from the doctor. If the notes do not provide you with enough information for an accurate ICD-9 code, you may have to ask for clarification. For example, if the doctor writes "heart failure" in the patient's record and you use only the [...]
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