Cardiology Coding Alert

Question: When on-call, can I bill for interpreting an electrocardiogram (ECG) that the hospital faxed to my home at 2 a.m.? What about the travel time to and from the hospital at 2 a.m.?

Tennessee Subscriber

Answer: Generally, you should not report interpreting the ECG with 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) because a physician in the hospital usually reads these ECGs. If you report 93010, you would be double billing the carrier for the same services.

Generally, Medicare does not reimburse for travel time to and from local hospitals, nursing homes and other facilities, regardless of the time of day it occurs. It does recognize, however, extraordinary circumstances when travel should be paid. Medicare's national operational policy regarding unusual travel states the following:

A. Unusual travel will be covered by Medicare Part B in those rare cases where the following conditions are met:

1. The distance to be traveled is unusually long (e.g., over 100 miles each way); and
2. There are no other physicians qualified to perform the service within that distance of the hospital.

B. A report must be sent with the claim describing the circumstances and distances involved. This will be reviewed on a case-by-case basis. Only one trip will be paid regardless of the number of patients seen or services provided.

If the cardiologist meets these criteria, you should bill the travel time and expense with 99082 (Unusual travel [e.g., transportation and escort of patient]) and be sure to include a report and cover letter. Cite Medicare Carriers Manual section 15026 and national coverage policy PHYS-054 in your cover letter.