ED Coding and Reimbursement Alert

CCI also wraps up E/M, counseling codes.

The correct coding initiative (CCI) version 17.1 arrived earlier this month with several bundles relevant to ED coders. Check out this rundown of the CCI edits so you can submit spot-on claims each time.

Break rhythm strip bundle with modifier

The newest CCI bundles 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) as well as 93042 (Rhythm ECG, 1-3 leads; with interpretation and report only) with 92950 (Cardiopulmonary resuscitation [e.g., in cardiac arrest]), confirms Michael Granovsky, MD, CPC, FACEP, president of MRSI, an ED coding and billing company in Woburn, Mass.

There are, however, some exceptional circumstances in which you could unbundle the two codes with modifier 59 (Distinct procedural service), Granovsky confirms.

When? "You could report both codes if you had a patient that presented initially with chest pain and required an EKG that later, after those interpretations were performed, subsequently crashed and required CPR," Granovsky explains. "However you could not report 93042 if during CPR you momentarily stopped compressions to check the monitor for return of normal rhythm," he says.

Consider this example:

A patient presents complaining of chest pain and shortness of breath; encounter notes indicate he also has a history of coronary artery bypass grafting (CABG). After the initial exam rules out an active myocardial infarction (MI), the patient is placed in observation, where a rhythm EKG is interpreted and additional tests are performed.

Later, the patient's chest pain increases dramatically and he experiences an acute MI that ultimately requires CPR.

Since there was a significant interval event between the two services, you might report 93042 and 92950-59, Granovsky says.

E/Ms Contain Counseling Codes Now

In addition to the CPR/ECG bundles, the behavior change intervention (alcohol/substance abuse) codes are bundled into many other E/M codes, Granovsky confirms.

This bundle includes the CPT^® codes 99408 and 99409 and the HCPCS codes G0396 and G0397.