Wiki INDEPENDENT INTERPRETATION OF TESTS

[RABBIT2020]

In the ED the radiology dept bills for the CT/US/Xray
The ED provider has the option to either bill the EKG cpt and or count it towards mdm as determined.
When there are repeat EKG to evaluate the same presenting problem we are advised to consider one ekg as independent interpretation and the other as a cpt.

It has been outlined to me in my coding department that should both of these show up as independent interpretation in the progress note that count the other CT/US/Xray towards independent interpretation of tests and code the cpt for ekg.

For instance an ekg and a CT were performed with 3+ labs for a presenting condition.
The progress note has:
independent interpretation EKG: sinus tachycarda, rate 112, no significant ST elevation nor depressions.
independent interpretation CT: no pathological finding with aorta nor heart.

Due to the finalized note:
the problem was determined to be HIGH
the data - 3+ labs and independent interpretation of test for CT EXTENSIVE
Hence:
99285 + ekg 93010

Is this considered a good, acceptable practice?

 

[thomas7331]

Counting the radiology services as independent interpretations makes sense - the ED providers aren't radiologists and probably shouldn't be billing for the interpretation (and if they did so it could potentially cause the radiologists' claims to deny as duplicates), but they do need to review the films themselves in the ED setting and may not be able to wait for a radiologist's report to be completed.

With the EKGs, it may be appropriate for them to bill for the interpretation if your facility doesn't have these reviewed separately by a cardiologist, though. The instruction to bill one and count the other as part of the E/M is a little odd, but I don't know that there's necessarily anything wrong with it. A second EKG would likely often be denied as a duplicate and due to the low reimbursement for that procedure, it wouldn't be worth the cost to fight the denials with the payers, so I can see that they might want to use that work as part of the E/M level rather than trying to bill a second interpretation that isn't paid much even under the best of circumstances. I don't know of any regulation that says this has to be done one way or other. And given the minimal money at stake here, I think it's unlikely any payer would aggressively pursue a detail like this in an audit.