Internal Medicine Coding Alert

Published on Sun Mar 28, 2010 PDF

For medically necessary ECG + IPPE, add this tool.

ECG CPT codes (93000, 93005, 93010) apply only when there are documented signs and symptoms or other clinical indications for providing the service. Whenyou're in preventive territory, switch to HCPCS codes.

Reason: "ECG services are not covered when rendered as a screening test or in conjunction with a routine examination," says Ashleigh A. Raubenolt,CPC, CPC-H, CPC-P, CPMA, CEMC, CHCA, director of chart watch auditing and review, and credentialing and physician contracting, at S.A. Medical of Virginia Inc. in Fredericksburg, "unless performed as part of the one-time, ‘Welcome to Medicare' initial preventive physical examination (IPPE) (G0402, Initial preventive physical examination; face-to-face visit,services limited to new beneficiary during the first 12 months of Medicare enrollment to new beneficiary during the first 12 months of Medicare enrollment) under section 611 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003."

To report a one-time ECG screening for a new Medicare beneficiary, choose from one of the following codes -- and do not append modifier 26 (Professional component) or TC (Technical component):

G0403 - Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

• G0404 -- Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report,performed as a screening for the initial preventive physical examination

G0405 -- Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination.

Attention: The day of the IPPE is not the only opportunity to report an ECG screening service. If the primary physician or qualified non-physician practitioner does not perform a screening ECG as a result of the IPPE visit, another physician or entity may perform and/or interpret the ECG, states the Medicare Preventive Services Guide, page 24 (www2.cms.hhs.gov/MLNProducts/downloads/PSGUID.pdf).

You may report other covered preventive services that the internist performs in addition to HCPCS code G0402 and the appropriate ECG HCPCS G code.

Also, if the patient requires an additional, medically necessary ECG in the 93000 series on the same day as the IPPE, report the appropriate ECG CPT code(s) with modifier 59 (Distinct procedural service), states the Medicare guide.