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Wiki EKG and Cath
- Thread starter Chelsea1
- Start date
cpc2007
Guru
Hi, the diagnosis for the EKG needs to be documented by the ordering physician. Therefore, the diagnosis for an EKG would vary based on why the EKG was ordered for that specific patient.
However, before you look for additional information for the diagnosis, since you mentioned the EKG was on the same day as a cath, I would first check to make sure the EKG can be unbundled from the catheterization. There is an NCCI edit between the EKG codes and all the cardiac catheterization codes. In the NCCI Policy Manual, Chapter 11, section I.16, there is an explanation of why this edit exists:
A cardiac catheterization procedure or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier 59.
While this guideline focuses on EKGs performed during the cardiac cath, and you mentioned that this EKG happened "the morning of" the cath (possibly before), if the EKG was obtained as a baseline and another EKG was run during or after the procedure to ensure there were no abnormal changes in response to the procedure, those EKGs would also bundle (they are for baseline/monitoring not for a true diagnostic purpose). Here's a great article from HCPRO that explains more: http://www.hcpro.com/HIM-265500-859/QA-Using-modifier-59-with-EKGs-and-cardiac-catheterization.html.
So with that said, I would make sure the EKG performed in the morning was truly diagnostic (meaning the patient was having some signs/symptoms or had a known condition such as afib that required further diagnostic assessment) that prompted the physician to order a diagnostic EKG. The reason for that EKG should be documented on the EKG report and/or an order for the EKG. If there is no diagnosis documented, that would increase the likelihood that this is just a baseline/monitoring EKG and not separately billable, but querying the ordering physician to verify would be best.
I hope that helps
Kim
www.codingmastery.com
However, before you look for additional information for the diagnosis, since you mentioned the EKG was on the same day as a cath, I would first check to make sure the EKG can be unbundled from the catheterization. There is an NCCI edit between the EKG codes and all the cardiac catheterization codes. In the NCCI Policy Manual, Chapter 11, section I.16, there is an explanation of why this edit exists:
A cardiac catheterization procedure or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier 59.
While this guideline focuses on EKGs performed during the cardiac cath, and you mentioned that this EKG happened "the morning of" the cath (possibly before), if the EKG was obtained as a baseline and another EKG was run during or after the procedure to ensure there were no abnormal changes in response to the procedure, those EKGs would also bundle (they are for baseline/monitoring not for a true diagnostic purpose). Here's a great article from HCPRO that explains more: http://www.hcpro.com/HIM-265500-859/QA-Using-modifier-59-with-EKGs-and-cardiac-catheterization.html.
So with that said, I would make sure the EKG performed in the morning was truly diagnostic (meaning the patient was having some signs/symptoms or had a known condition such as afib that required further diagnostic assessment) that prompted the physician to order a diagnostic EKG. The reason for that EKG should be documented on the EKG report and/or an order for the EKG. If there is no diagnosis documented, that would increase the likelihood that this is just a baseline/monitoring EKG and not separately billable, but querying the ordering physician to verify would be best.
I hope that helps
Kim
www.codingmastery.com