Cardiology Coding Alert

Never append modifiers 26, TC to EKG codes.

You’ve got numerous rules to remember when reporting routine electrocardiograms. If you’re not careful, you could be leaving money on the table.

Bust the following myths to make sure you always submit clean electrocardiogram claims in your cardiology practice.

Myth 1: ECG, EKG Are Different Procedures

Reality: ECGs and EKGs are actually two abbreviations for the same procedure — an electrocardiogram. An electrocardiogram is the recording of electrical activities of the heart and their interpretation by a physician.

Electrocardiograms explained: The Sinoatrial Node (located in the right atrium) sends electrical impulses to the heart muscles, which contract resulting in systole. A twelve lead ECG/EKG is obtained using ten electrodes placed on the skin over different regions of the body (limbs and chest), says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Electrical activities of the heart are recorded in those regions from these electrodes and these recordings are reproduced in a graphic format, Neighbors adds. Interpretation of these graphs helps to correctly diagnose heart disorders and conditions. These graphs help the physicians diagnose a real-time emergency, such as acute myocardial infarction, but they can also help detect patterns that emerge over time such as sinus bradycardia or even mitral valve prolapse.

Myth 2: You Can Append Modifiers 26, TC

Reality: Although for many codes you would indicate performance of only a portion of the service by appending either modifier TC (Technical component) or 26 (Professional component), that method does not apply for ECGs.

Instead, this family of codes provides separate options depending on whether the physician performs the entire service (93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report); the technical component only (93005, Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report); or the professional component only (93010, Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

Coding tip: To choose the appropriate ECG code, you should carefully check the documentation, according to Neighbors.

For example, if the cardiologist owns the ECG machine and performs the interpretation and report, then choose 93000, Neighbors explains. The ECG machine, supplies, interpretation and report are considered the technical and professional components of the service.

93000 example:  The cardiologist performs the ECG in his office, so you would report the complete component code 93000.

93005 example: When a facility provides an ECG on the patient, the facility would capture 93005, Neighbors says. The ECG machine and tracings are considered the technical component of the service.

93010 example: If the cardiologist performs the interpretation and report on an ECG performed in a facility only, then you would report 93010. This is considered the professional component of the service. Reminder: The facility owns the ECG machine and tracing, so the physician only reports the professional component of this service.

Myth 3: You Can Report ECG Codes With All Intracardiac Ischemia Monitoring T-Codes

Reality: The CPT^® guidelines specifically state that you should never report ECG codes 93000, 93005, or 93010 in conjunction with T-Codes 0525T (Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor))-0532T (Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only).