Cardiology Coding Alert

CPT 93000 codes will now require meeting modifier 59 criteria

If you're used to tacking on EKG codes when your cardiologist performs this service with another cardio procedure, get ready to change your habit.

The Correct Coding Initiative (CCI) version 14.2 attacks EKG service codes 93000-93010 (Electrocardiogram, routine ECG with at least 12 leads ...) and 93040-93042 (Rhythm ECG, one to three leads ...). Consider 93000-93010 and 93040-93042 a part of common cardiology procedures such as pacemaker codes 33206-33214, transluminal balloon angioplasty codes 35470-35476, central venous access device codes 36555-36565, cardioversion codes 92960-92961, and intravascular ultrasound codes 92978-92979, among others.

Remember: Comprehensive/component edits like these describe bundled procedures. That is, CMS considers the code listed in column 2 as the lesser service, which is included as a component of the more extensive column 1 procedure.

In all cases, these edits have a modifier indicator of "1," meaning you can bypass the edits with the modifier if the procedures are distinct from one another (for instance, if they occur in separate anatomic locations or during different sessions).

Interpret These Edits This Way

CMS considers the EKG a routine/nonbillable service when it is for intra-operative monitoring. If your cardiologist needs to do an EKG on a patient as part of the diagnostic workup and then makes a decision to do one of these common cardiology procedures, then you would apply modifier 59 (Distinct procedural service) to illustrate that the EKG was truly a separate service, says Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of CardiologyCoder.Com Inc. in Saratoga Springs, N.Y.

Example: A patient presents to the emergency room with symptoms of pre-syncope. The cardiologist does a workup that includes an EKG (93010, ... interpretation and report only). This reveals profound bradycardia, which necessitates the implantation of a pacemaker (33208, Insertion or replacement of permanent pacemaker with transvenous electrode[s]; atrial and ventricular). If you do not include modifier 59 on 93010, then your payer will consider it included in the work 33208 represents.

Rejoice in This EKG Deletion

Good news: You no longer have to worry about the mutually exclusive edit bundling 93042 (... interpretation and report only) and 92986 (Percutaneous balloon valvuloplasty; aortic valve). CCI deletes this pair.