Question PLEASE HELP! - EKG Reporting

Mchurch78

New
Messages
3
Best answers
0
Our organization started an outpatient Cardiology department about a year ago, and our cardiologists are sub-contracted through a different company and rotate through, but we do all the billing.

I currently have a cardiologist who is refusing to write any kind of a report, even in the patient's office visit note, surrounding the EKG stating he only has to initial the tracing for the professional component to be billable with the technical component (the machine is in-house). "In my 40 years practicing, I've never had anyone question the validity of that, and there's never a separate report written."

Now, we're new to Cardiology coding, but EVERYTHING I've read says "interpretation and report" are required to bill the professional component. I have tons of documentation surrounding this, from CMS, AAPC, and other physician's organizations. All the documentation states that a separate report (from the tracing) must exist in the patient's chart, even if it's just included in the chart note, and simply stating "EKG normal" is insufficient. I've presented all this documentation to him, and his answer was that I need to "check with other organizations to see how they're billing without a report."

So, please, HELP!! Are we in the wrong here? If not, can anyone provide me with some real-world samples? I've been fighting this for a week and I'm exasperated.

Thank you for any help you can offer!
 

Mchurch78

New
Messages
3
Best answers
0
That is EXACTLY my point. Thank you!!

And the kicker is that the Cardiology office and Ortho office are in the same location, and our Ortho docs are *immaculate* at their interp and reporting.
 

amcook31

New
Messages
5
Location
Santee, CA
Best answers
0
He is wrong. My previous company required the provider to list the indication, interpretation, any comparison images or reports (or state that there was no comparison available), and list their full name and credentials. The electronic signature only put the date it was signed. A couple years ago they didn’t have to so I don’t know if requirements changed or just started to be enforced.
 

heartyoga

Guru
Messages
154
Location
Cookeville
Best answers
0
Our hospital uses a system (Ephiphany Cardio-server) that requires the doctors to log in, read and check boxes or free type his interpretations. Typical interpretative statements may include "sinus bradycardia", "mild interventrular conduction delay" ,"junctional rhythm" "sinus rhythm", "non specific t wave abnormality", "long qt interval","sinus tachycardia","normal ecg""atrial pacemaker present", "low qrs voltage in precordial leads"," no old ecg in archive for comparison".
From the description of your situation, the doctor may be relying on the EKG machine's preliminary interpretation, and adding/correcting/agreeing with the preliminary interpretation.
I suggest looking from the doctor's point of view with reimbursement comparably small and the volume might be big, he may not want to spend more time (unnecessary in his viewpoint) when he has other patient responsibilities, and other documentation requirements he has to face.
Check with your administration if they would consider investing in a system that would allow the doctors to log in, interpret, click, free type and the system automatically generates a report.
While the EKG reimbursement are seemingly miniscule (compared to other cardio procedures), Medicare may randomly audit if your volume is high and having an EKG report definitely helps support the necessity and coding.
 

Mchurch78

New
Messages
3
Best answers
0
Our hospital uses a system (Ephiphany Cardio-server) that requires the doctors to log in, read and check boxes or free type his interpretations. Typical interpretative statements may include "sinus bradycardia", "mild interventrular conduction delay" ,"junctional rhythm" "sinus rhythm", "non specific t wave abnormality", "long qt interval","sinus tachycardia","normal ecg""atrial pacemaker present", "low qrs voltage in precordial leads"," no old ecg in archive for comparison".
From the description of your situation, the doctor may be relying on the EKG machine's preliminary interpretation, and adding/correcting/agreeing with the preliminary interpretation.
I suggest looking from the doctor's point of view with reimbursement comparably small and the volume might be big, he may not want to spend more time (unnecessary in his viewpoint) when he has other patient responsibilities, and other documentation requirements he has to face.
Check with your administration if they would consider investing in a system that would allow the doctors to log in, interpret, click, free type and the system automatically generates a report.
While the EKG reimbursement are seemingly miniscule (compared to other cardio procedures), Medicare may randomly audit if your volume is high and having an EKG report definitely helps support the necessity and coding.
Thank you for your response. Our EHR does have that functionality (I did not know that initially), however, he refused to use it. So after speaking with our Director of Compliance, our Medical Director, and the Medical Director of his contracting agency, I got together with IT and made it a mandatory function to be able to close out the chart note. Now he can't bypass it, and we get the documentation that we (and other local providers that have complained about his lack of documentation) need.

Basically, the problem was/is that he doesn't care if we get reimbursement for anything, or if basic documentation standards are met, as he's paid through the contracting agency regardless. However, we're very rural, and every penny literally counts for us, so it's my job to make sure we get all the reimbursement we can for the services we're providing - no matter how unnecessary he believes it to be.
 
Top