Cardiology Coding Alert

Question: I read that a pre-procedure EKG is included within the primary procedure unless it’s the initial EKG that determined the definitive diagnosis. And, if this EKG is only performed to identify a patient’s rhythm before sedation, it’s included within the primary procedure. But, what happens if the physician who is providing the EKG service is not the same physician performing the surgery?

Pennsylvania Subscriber

Answer: If there is no medical necessity to support a separately identifiable (modifier 59 or XU) electrocardiogram (EKG), then this EKG is considered part of the surgical package. Therefore, you should not separately report it, regardless of who performs the professional component of the procedure. This is true especially when both physicians work for the same practice and use the same Tax ID Number.

As a reminder, please review modifiers 59 (Distinct procedural service) and XU (Unusual non-overlapping service) thoroughly before appending these modifiers to a procedure. Just because a procedure allows a modifier doesn’t mean it’s appropriate to append the modifier to clear an edit without medical necessity.