Cardiology Coding Alert

Question: Medicare stopped requiring ECGs for the IPPE (initial preventive physical exam). Does that mean I should report a CPT code (such as 93000, Electrocardiogam ...) when the cardiologist performs ECGs for IPPE patients?

Michigan Subscriber

Answer: If a physician sends a patient to you for a screening ECG as part of the IPPE, the appropriate ECG codes to choose from include:

• G0403 -- Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

• G0404 -- ... tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

• G0405 -- ... interpretation and report only, performed as a screening for the initial preventive physical examination.

Although CMS no longer mandates the ECG as part of the IPPE, CMS does allow a once-in-a-lifetime screening ECG with referral from an IPPE.

The physician or non-physician practitioner providing the IPPE reports G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment).

Remember: The IPPE and related screening ECG are billable only within the patient's 12-month enrollment period (that is, within the first 12 months after the effective date of the patient's Medicare enrollment).