Tact Your EKG Interpretation Claims With This Can't Miss Documentation Guidance

Does your chart include the needed elements to stand up under audit?

In case you're getting repeat denials when your ED physician reads electrocardiograms [EKG], it's time to ask yourself some serious questions, comprising whether the documentation meets Medicare's definition of interpretation and whether the notes clearly classify which ED provider did the reading and reason behind the EKG was ordered. Read this article to ensure accurate medical coding.

Reality: One of the most commonly reported non-E/M services in the emergency department is for EKG interpretation; unfortunately, if you execute CPT Lookup, you will find that these CPT codes also fall under the most commonly contested services as well.

E/M link: A review of a formerly interpreted EKG has value in E/M code Medical Decision Making, but in a totally diverse way from being distinctly billable.

Watch Out for Rhythm Report Reason

CPT Lookup: The CPT® book includes two CPT codes defining interpretation as well as report of diagnostic cardiographs or the tracings of heart rhythms.

93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only)

93042 (Rhythm ECG, 1-3 leads; interpretation and report only)

In the case of the 93042 code, you would not report it when the ED physician just reviews the telemetry monitor strips taken from a monitoring system. The needed definite order for 93042 must be supported by a diagnosis or symptom as the starting event. For supporting medical necessity for the service, clinical information representing the need to assessing for the presence or absence of an arrhythmia, cardiac ischemia, or further cardiovascular problem must exist within the medical record.

In the ED, the physician would not normally report the global CPT codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) as the physician does not usually own the EKG machine nor employ the staff who in fact administers the test.

Code choice aside, some payers reject to reimburse for diagnostic interpretations in the ED setting, stating they are bundled into the E/M service and counted in the amount and difficulty of data reviewed component of medical decision making.

CPT Lookup Tip: EKG services must be distinctly reimbursed except there was simply a "review" of the tracing delivered rather than the CPT® defined independently distinctly identifiable signed written report. CPT® is quite specific in the E/M services guidelines that the actual presentation and/or interpretation of diagnostic tests/studies ordered in a patient encounter are not involved in the levels of E/M services. Physician presentation of diagnostic tests/studies for which definite CPT codes ( Source "http://www.supercoder.com/cpt-codes/" )are available may be reported distinctly, as well as the suitable E/M code if correctly documented.