93000 vs 93005


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We have patient's that come in for routine physicals as well as pre-op physicals the MA does an electrocardiogram. They usually bill a 93000 (with interpretation and report) but the only documention I see in the note says "routine". What kind of documentation is needed to justify the 93000 or should we be billing 93005 (tracing only)?

Hi. If these are Medicare patients you are referring to, then the physician can't bill for routine EKG because Medicare doesn't pay for routine anything. For other patients, I would think that 93005 would be the most appropriate code to bill. 93000 requires, in addition to medical necessity, the physician's actual documentation of interpretation and a report on that interpretation and some type of authentication or signature. If I don't find this information on the tracing, I usually look in the progress notes. Normally, you would expect a the information on the tracing with a reference in the progress notes. Keep in mind that I'm speaking from exclusively doing Medicare reviews. Your carrier should have information on their website regarding your question. Hope this helps.
On Medicare patients who are having their "welcome to Medicare" physical we bill G0367 and G0368 for the EKG with dx V70.0. That's the only time Medicare is ok with the routine EKG. On our preop patients we bill (unless there is a different medically necessary reason documented) V72.81 (preop cardio exam) and a secondary of the condition that prompted the surgery e.g., osteoarthritis leg, or degenerative joint disease, etc.
EKG with interpetation and report is when An MD reads the EKG and reports their findings. A Tracing is the Peice of paper that comes of the EKG machine - usually pink and white. If your office does not read their EKG's and sends them out to say a cardiologist, then 93005 would be the code - like the technical and professional component of Xrays.