ED Coding and Reimbursement Alert

Question: Can you please provide me with your general understanding of when and what information is required for billing a cardiac monitor? Currently, our doctors are billing for the cardiac monitor strip only if they have an order placed, the MD interpretation and the rate and rhythm documented… Sinus Tachycardia with a rate of 108.

One question my providers are asking if they can bill multiple readings if they are monitoring the patient after they have provided their treatment or converted the patient to a normal sinus rhythm?

Illinois Subscriber

Answer:  You are correct in the first part of your question that an order is needed for the monitor strip interpretation. Since 2008, both the 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) and 93042 (Rhythm ECG, one to three leads; interpretation and report only) have these requirements for reporting:

• Have a specific order for the diagnostic test 
• Have documentation in the medical record supporting the need for the diagnostic test 
• Have a separate, signed, written and retrievable report; and an interpretation of the diagnostic test

In addition, rhythm ECG services are appropriate when:

• The order for the diagnostic test is triggered by an event 
• The diagnostic test is used to help diagnose the presence or absence of an arrhythmia

CPT® says in the Instructions for Reporting Electrocardiographic Recording that codes 93040-93042 are appropriate when an order for the test is triggered by an event, the rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is generated. There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report. It is not appropriate to use these codes for reviewing the telemetry monitor strips taken from a monitoring system. The need for an electrocardiogram or rhythm strip should be supported by documentation in the patient medical record.

You could report up to three instances of 93042 based on the medical unlikely edits (MUE), as long as the medial necessity was clear in the chart documentation. The rules were changed to prevent paying any provider who comes by and looks at the monitor from repotting and interpretation service.

Caveat: Be sure you are reporting the right service with your code choice. According to CPT® coding principles, a provider should select “the procedure or service that accurately identifies the service performed.”  If it is generally accepted that a complete 93010 service encompasses an interpretation and report of rhythm, then it would be inappropriate for a single provider to code for both 93010 and 93042 based upon a single 12-lead ECG tracing. 

However, if for a particular patient encounter both 12-lead ECGs and rhythm ECGs were medically necessary,  separately performed, and interpreted by a provider, then CPT® principles would allow the provider to code all the appropriate services. Though, once again, be aware of the CCI edits.