Revenue Cycle Insider

Question: Can I report 93000-93010 when a nonphysician practitioner (NPP) produces a reading of an electrocardiogram (EKG)?

South Dakota Subscriber

Answer: If you’re billing CPT^® codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) through 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only), most commercial payers require an MD or DO to read the EKG and offer their interpretation and report in order for the claim to be paid.

Reading and interpreting an EKG can factor into a physician’s medical decision making (MDM), which can lay the foundation for their eventual report and the evaluation and management (E/M) code for the entire encounter. Even if a physician interprets the EKG and produces a report, you may still run into trouble getting these codes paid depending on the circumstances in which the EKG is performed, like whether it was a routine screening or if the clinician had documented a medically necessary reason to administer the test.

There’s a chance that a government payer providing care to underserved communities may pay for EKG reading services performed by an NPP, but if it this were possible, it would depend on the NPP’s scope of practice and whether their training provided them with the education and knowledge to produce an accurate interpretation/reading and report. Check with your respective payers to confirm what credentials or circumstances they require to ensure reimbursement for EKG services rendered. 

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC