Cardiology Coding Alert

Question: As an HPSA, must we submit component codes when we provide a complete ECG?

Tennessee Subscriber

Answer: Although you currently have to break down the electrocardiogram (ECG) service, this extra work is about to end.
 
Cardiologists billing Medicare carriers for the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) bonuses must submit the component codes for ECGs even when the practice furnishes the complete service. CMS made this a coding requirement to properly allocate bonus payments on only the professional portions.
 
New way: Starting July 1, you should instead use the global ECG code (such as 93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). Change Request 5015 "will allow physicians to submit global services and receive the HPSA and PSA bonus without having to submit the professional component and technical component (PC/TC) separately," CMS explains in MLN Matters Number MM5015.
 
How it works: A coder in an HPSA or PSA bonus payment area submits a claim for a complete ECG. Until June 30, she should split out the service using:

 • 93005 -- Electrocardiogram, routine ECG with at least 12 leads; tracing only,  without interpretation and report
 • 93010 -- ... interpretation and report only.

For claims dated July 1 and later, she should report the global code 93000.
 
Important: The change will apply to all professional component/technical component codes except for procedure code 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report). Continue to use separate component codes when reporting cardiovascular stress tests.

 -- You Be the Coder and Reader Questions were prepared with the assistance of Jim Collins, ACS-CA, CHCC, CPC, CEO of the Cardiology Coalition and compliance manager for several cardiology groups around the country; and reviewed by Jerome Williams Jr., MD, FACC, a cardiologist with Mid Carolina Cardiology in Charlotte, N.C.