# EKG interpretation documentation requirements



## jmlarzzaapc

Can anyone please clarify the EKG interpretation documentation requirements  for the ED (CPT 93010)?

I know the following;

that an order needs to be present

there must be documentation in the medical record supporting the need for the EKG

there must be a separate, signed, written and retrievable report and an interpretation of the EKG that includes at least 3 of the 6 elements -  axis; rhythm; rate; PR intervals, ST wave changes; comparison to a prior EKG (if reviewed)

The physicians at our hospital provide a signed order, sign off on the EKG report and they include in their ED dictation 'EKG shows' or 'EKG reviewed' and they will list the 3-6 elements of the EKG, but rarely will not elaborate any further.  The ED dictation is signed by the physician and it always lists diagnoses that cover the order of the EKG.

Is this sufficient enough documentation to bill 93010? OR does the physician need to state 'EKG as interpreted by me?'

Can someone please help me out?  Thank you!


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## sam_son 

*Ekg*

Hi 

In coding EKG (93010) ,  For government payers reviewing of 3 elements by the physician is needed to code EKG . 

For Self pay and commercial payers one element is enough to code and/ or EKG interpreted by me is enough to code EKG. 

Hope it helps


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## LindaEV

Samson, do you have any resources or links for this info? Not that I don't believe you...just happen to be working on this issue with a doc who wants it "in writing" and I cant find anything on the CMS site or our local carrier site.

Linda


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## TAOSA

I am having the same discussion in my office. Can anyone provide an official statement about the 3 of 6 rule?  Please!

Tiffany, CPC


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## chimera07

*EKG's Rule per CMS*

EKGs

•	Document the interpretation of the tracing in a separate section of the ED chart.

•	For EKGs, the interpretation must include appropriate comments on any 3 of the following 6 elements: (1) the rhythm or rate (2) axis, (3)intervals, (4) segments, (5) notation of a comparison with a prior EKG if one was available to the ED physician, and (6) summary of clinical condition.

"An EKG with interpretation must have the full graphic tracings with formal written or printed interpretation on file for review.  The interpretation should appear on the designated sections of a page formatted EKG or written in the clinical records.  Interpretations should include appropriate comments on rhythm, axis intervals, acute or chronic changes and a comparison with the most recent tracing.  While every single parameter is not required for each tracing, the appropriate measurements must be mentioned if the purpose of repeated EKGs is to monitor the effects of a given parameter, e.g., the QT interval.
	Medicare CAC, June 1995

For example:

-	EKG reveals normal sinus rhythm, no axis deviation, no acute changes.

-	EKG reveals normal axis and intervals, no previous EKG for comparison.

-	EKG reveals atrial fibrillation, rapid ventricular response, non-specific ST-T wave changes

-	EKG reveals normal sinus rhythm, normal axis, T-wave inversion in V3 and V4 and T-wave flattening and high laterally.  No EKG was available for comparison.

-	EKG reveals normal sinus rhythm with rate of 66, PR and QRS intervals within normal limits, some QRS complexes in lead III and T-wave abnormalities in I and aVL, but when compared to prior EKG there is no acute change noted.

RHYTHM STRIPS

Rhythm strip interpretations cannot be billed when they are done at the same time as a full EKG. However, they can be billed when performed at a time different than the EKG and when the medical necessity of the rhythm strip is clear. When clearly necessary, each may be billed separately. Documented change in a patient's condition or response to medication would allow separate reporting of a rhythm strip after an EKG was done.


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## jaciwismar

jmlarzzaapc said:


> does the physician need to state 'EKG as interpreted by me?'



This is the part I'd like clarification on .   He states his interpretation but doesn't use the words 'interpreted by me'   

Thank you
Jaci


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## denisebecker

*EKG Interpretation*

with today's technology- is it acceptable that a physician clicks "accept" on a template to accept the machine interp?  Would this support us billing the global charge if he/she didn't perform a personally documented interp?


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## MandyFlagg

I understand this post is from quite a while ago; however, I am trying to find the below information within the CMS manual and I cannot.  Can someone please guide me to where this is located?

Thanks, 
Mandy


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## AmandaBriggs

The link below should take you to the NCD from CMS for electrocardiograms. 

https://www.google.com/url?url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/r26ncd.pdf&rct=j&frm=1&q=&esrc=s&sa=U&ei=ITPVVJCYIca4ogSStIDQBg&ved=0CBQQFjAA&sig2=yAfyQv9Vx7bwfdvgcmcNlg&usg=AFQjCNHUFmLhVaCdL3hjcQUJoxJH9dh9tA

Hope this helps!


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## mzprince2002

*Tracey*

Hello friends,

I know this is a dated question, but still an issue.  I was looking for the same information in writing from Medicare. This is not an LCD policy, but a documentation requirement that is no longer available to print.  

I contacted a representative at noridian to see if they had the Medicare CAC dated June 1995.  The representative responded quickly with "Are you sure it's that old?  Because we don't have anything on our website that old."

So...I provided them with what I did find in writing.  This comes from the Emergency Groups' Office dated 01/22/2010.  The final page (8/8) has the direct policy quote citing the Medicare CAC dated June 1995. 

Here is the link to that complete article: 

http://cdn2.hubspot.net/hub/21300/file-13421231-doc/mngmt advis/xray_ekg_advisory_jan_2010.doc


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