ED Coding and Reimbursement Alert

Fight for electrocardiogram (EKG) interpretation payment in the ED otherwise, Medicare will send reimbursement for your ED physicians to cardiologists. Don't give Medicare any reason to doubt the medical necessity of this service. When you report 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only), make sure your physician's documentation supports a contemporaneous interpretation one that is a timely and direct contribution to patient diagnosis and treatment.

In addition, ensure the interpretation is a complete, written report, similar to that prepared by a specialist, says Robert Kottman, MD, at Alamo Physicians Services Inc. in Universal City, Texas. Only a "report" of this kind will support a separate interpretation code. If the ED physician merely reviews a particular tracing or film after another physician has interpreted it, you should include this work in the E/M code, he says.

The way to improve documentation for EKG payment is to nail down the details of cardiology reports. You should also master your coding for rhythm strips and critical care. Your EKG claims could meet resistance from payers, especially if cardiologists are charging over-read services for the same EKG, but perfecting these details will help you defend your claims. (To read more on basic and general information on this topic, refer to "Be the First to the Finish Line With EKG and X-Ray Interpretation" and other related articles in the December 2002 ED Coding Alert.) Get Familiar With Specialty Reports What do references to p waves and QRS complexes in the physician's notes mean? If you're not sure, you should brush up on cardiology terminology that will help you identify complete EKG reports required when you submit EKG interpretation codes for ED physicians. A complete cardiology report should include rhythm and rate, axis, intervals, p waves, the QRS complexes and ST segments, and T waves, Kottman says. In case you're unfamiliar with these terms, he provides four helpful definitions:

Pwave: a record of the movement of electrical activity through the upper heart chambers and recorded when they contract

QRS complex: a record of the movement of electrical impulses through the lower heart chambers and recorded when they contract ST segment: appears as a straight, level line between the QRS complex and the T wave. Elevated or lowered ST segments may mean the heart muscle is damaged or not receiving enough blood

T wave: corresponds to the period when the lower heart chambers are relaxing and preparing for their next muscle contraction. Because your physicians need reports similar to a specialist's to secure payment for their interpretations in the ED, let them know what a complete cardiology report entails and provide an example of a thorough statement. Kottman offers [...]