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Cardiology Coding Alert

Pre-Op EKGs:

Quick Reimbursement Tips

Published on Sun Aug 31, 2003

All too often, cardiologists perform preoperative electrocardiograms (EKGs) and either don't bother billing them or get denials and give up. But cardio coding experts say that you can get reimbursed for pre-op EKGs if the physician's documentation establishes medical necessity and if you append modifier -59 (Distinct procedural service) to the appropriate EKG code (93010-93237).
 
Routine screening EKGs prior to procedures aren't billable, but you can report a preoperative EKG when the physician orders the study for a separately identifiable reason, such as chest pain or palpitations, says an American College of Cardiology (ACC) spokesman.
 
"We're getting paid for pre-op EKGs for heart catheterizations (93510-93533) because we're using not only the pre-op diagnosis code (V72.81, Pre-operative cardiovascular examination) but also the code warranting the pre-operative EKG, such as 786.50 (Chest pain, unspecified)," says Belinda Inabinet, CPC, technical support manager and head of the coding team at South Carolina Heart Center, a 21-physician practice in Columbia, S.C. 
  
Even when you establish medical necessity for a pre-op EKG, payers may be reluctant to reimburse when the physician performs the EKG on the same day as the procedure. "Our Medicare carrier rarely pays pre-op EKGs, so we ask patients to sign a waiver so we can bill them for the EKG," says cardiology coder Kim Greer, CPC, with Ohio Valley Heart Care in Evansville, Ind.
 
To indicate further to payers that the EKG is a separate service, append modifier -59 to the EKG code; otherwise, payers may bundle the EKG into the procedure, the ACC says.
 
For instance, a patient presents to the emergency department with acute chest pain, and the physician sends him to your cardiologist for a consultation. To rule in/out a cardiovascular cause for the patient's symptoms, the cardiologist performs an EKG, which reveals an acute myocardial infarction. He decides to perform an urgent catheterization with possible stenting (92980). Because the documentation indicates a medically necessary EKG on the same day as a heart catheterization, you should report the appropriate EKG code in addition to the codes for heart catheterization and intervention and append modifier -59 to the EKG code.

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