ED Coding and Reimbursement Alert

Answer: The E/M and ICD-10 code are easy enough to assign for this encounter. Report 99285 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components:

A complete history; A complete examination; and Medical decision making of high complexity…) with I49.8 (Other specified cardiac arrhythmias), which lists nodal rhythm disorder as coded with I49.8. (Remember, you don’t need to code for the chest pain, as the physician reached a more definitive diagnosis during the encounter.)

As for the ECG, it’s a bit opaque. There’s a couple of unanswered questions in your notes, and you’ll likely have to go back and check the documentation, or talk to the provider, before you can code this claim.

Why? You don’t know what your physician’s role in the ECG was; further, you don’t know what kind of ECG your physician performed.

If they performed a 12-lead (minimum) ECG, then you’ll choose from the following codes, depending on your physician’s involvement:

• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report)
• 93005 (… tracing only, without interpretation and report)
• 93010 (… interpretation and report only)

If they performed an ECG with one to three leads, then you’ll choose from the following codes, depending on your physician’s involvement:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report)
• 93041 (… tracing only without interpretation and report)
• 93042 (… interpretation and report only)

Go back and check the notes to see if you can find anything that might indicate which ECG code set to choose from. Or, if possible, talk to the physician before coding. In the ED, since the provider does not own the equipment or employ the ECG tech, the correct codes will most likely be 93010 for the 12-lead ECG and 93042 for the three-lead tracings.