Help with Emergency Dept CPT Codes

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Hello, I was wondering if someone can give me advise on how to figure out when to add a EKG or a chest xray to the CPT codes. There must be some clue as to when to apply it. I tried so many scenarios on Practicode and it's not clicking. Is there a way to know when they are suppose to be added along with the E/M code? I can't tell when it is bundled in the service or considered extra. Thank you for any help.
 

Pam Brooks

True Blue
Local Chapter Officer
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I'm going to take a stab here. Are you coding for the ED physician? If so, he's not going to personally do either the EKG or the CXR. That will be done by the imaging folks, billed by the facility, and the reads will be done by radiologists and cardiologists. Although he might do a quick read, he's not going to be doing the interpretation and report. I think that the ordering of the EKG or CXR are for you to count into your data for your E&M level of service. So you have two data points, one for rad and one for medicine. You count that towards your MDM when calculating your E&M.

The only time you'd ever add a EKG or CXR to a physician's bill is if the practice owns the equipment, and their employees administer the diagnostics and the tests are being done in the practice where the overhead is considered.
 
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Yes it is for the ED physician. I am so confused because it will say they read the report or state what is on the EKG but I don't see a pattern on when Practicode's answers include the EKG or xray. I feel bad because it's kinda a ridiculous question but I'm pulling my hair trying to get these Practicode answers right. It's in reports that state "Emergency Room" on top and it is for an emergency room encounter. There will always be an E/M code but when I apply the EKG with a rhythm strip I am so lost. I was hoping for the black and white clue on the report that would lead me but I just can't find anything consistent.
 

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
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If you're coding for the physician in the ED, you are never going to assign the codes for the EKG, radiology, etc., provided by the hospital staff. You would consider the discussion of these diagnostic tests only for calculating your data points for MDM. They're telling you that they read the report because that is what you need to know to assign data points in E&M coding. They're not asking you to assign a CPT code for the EKG, they are telling you that you count that information for their Data portion of the MDM. You wouldn't ever assign codes for diagnostics as a pro-fee coder when the physician is working in the facility as long as the facility staff is performing the diagnostics. The reason they are telling you that the provider is in the Emergency Room setting, is so you assign the CPT codes for the E&M visit from the correct section.
 
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