Cardiology Coding Alert

Question:  Is there a modifier or a procedure code for the following? Patient comes into the office and has an EKG. The physician doing the EKG reviews, interprets, and provides a written report. Then another physician comes in (same practice) and over-reads the EKG reports done by the previous physician. Is there something that can be billed for this?

Codify Member

Answer: You’re unlikely to see payment for the second interpretation unless you have strong documentation supporting medical necessity. For instance, if an individual, extraordinary case requires the expertise of someone with more specialized training than the first physician can provide, you could try to argue for the additional payment, assuming the second physician writes a full report as well. Payers may request the use of modifier 77 (Repeat procedure or services by another physician or other qualified health care professional) in that situation.

Consider this quote from Medicare Claims Processing Manual, Chap. 13, Section 100.1, about tests in emergency departments: “Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished to an emergency room patient. They pay for a second interpretation (which may be identified through the use of modifier ‘-77’) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.”

Keep in mind: Medicare’s national fee for 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) is less than $9. If payment for the over-read will require an appeal, you may want to weigh the cost in time and effort against the expected reimbursement.