ED Coding and Reimbursement Alert

Don't let an official qualification hold you back from coding medically necessary and reimbursable services rendered in the ED. The ED physician doesn't need a cardiologist's reading to make medically viable decisions. As opposed to the past, most EDs now have board-certified emergency medicine physicians or permanent emergency physicians, experienced specifically in emergency medicine, and they read EKGs "very well," says Robert LaFleur, MD, FACEP, president of Medical Management Specialists in Grand Rapid, Mich.

If you include the work done interpreting EKG and x-rays under the E/M code, you lose out on reimbursement for work done as a distinct service that requires special skill, La Fleur says. What's included in the E/M guidelines is the ordering of tests.

You can code separately for the EKG interpretation if you provide documentation that the ED physician reviewed it. The CPT manual states, "The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M service."