Take Heart:
Rhythm Strips May be Paid in Some Cases
Published on Fri Mar 01, 2002
Emergency department (ED) physicians often review and interpret rhythm strips on patients with cardiac symptoms. Nonetheless, claims for these legitimate services are often denied by Medicare and private payers because rhythm strips are a component of a more comprehensive 12-lead electrocardiogram (ECG or EKG), which is typically read by cardiologists. When both physicians attempt to receive reimbursement for services rendered to the same patient on the same date, the ED physician charges usually go unpaid. In fact, the Correct Coding Initiative (CCI) has implemented an edit prohibiting codes describing these services from being reported together during the care of a Medicare beneficiary.
When a patient with a suspected cardiopulmonary disorder is seen in the ED, the physician will usually order a 12-lead ECG. "Each lead provides a different view of the heart," explains Michelle Ashby, CRNP, of The Heart Group in Lancaster, Pa., which employs 12 nurse practitioners and 13 cardiologists. "Some of the leads provide information about the anterior wall of the heart, while others reflect the lateral and inferior walls, for example." The interpretation and report for a complete 12-lead ECG are reported with 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).
Each lead collects about three seconds of information at a time representing only a couple of heartbeats, she adds. "At the bottom of the ECG, there is usually a longer section of one to three leads. This rhythm strip is used to determine the rhythm of the heart. The ED physician can tell if patients have normal sinus rhythm, for instance, or if they are suffering from a problem like atrial fibrillation [427.31]," Ashby says. Interpretation of a rhythm strip is described in 93042 (Rhythm ECG, one to three leads; interpretation and report only). Usually, the ED physician will use the information from the rhythm strip to help determine a diagnosis. Later, a cardiologist may review the details contained in the entire ECG strip.
Neither Service Is Considered 'Distinct'
"When you look at the issue logically, the rhythm strip interpretation is a distinct service, provided at a separate time by a different physician than the full interpretation of the 12-lead ECG," points out Mason Smith, MD, FACEP, CEO of Lynx Medical Systems, a facility and physician coding and billing service based in Bellevue, Wash. "You would think both physicians should be able to report the service. But payers don't see it this way. They see the full 12-lead interpretation as including the initial rhythm strip service. It is a controversial area that has been discussed at great length."
In some instances, Smith says, ED physicians attempt to use [...]
