ED Coding and Reimbursement Alert

Find out the scoop about appending modifier TC to ECG claims.

Your ED is likely to perform electrocardiograms every day, but sometimes the coding rules can still be confusing. Bust the following myths to make sure you always submit clean ECG claims.

Myth 1: ECG, EKG Are Different Procedures

Reality: ECGs and EKGs are actually two abbreviations for the same procedure — an electrocardiogram. An electrocardiogram is the recording of electrical activities of the heart and their interpretation by a physician.

Electrocardiograms explained:  The Sinoatrial Node (located in the right atrium) sends electrical impulses to the heart muscles, which contract resulting in systole. A twelve lead ECG/EKG is obtained using ten electrodes placed on the skin over different regions of the body (limbs and chest), says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.

Electrical activities of the heart are recorded in those regions from these electrodes and these recordings are reproduced in a graphic format, Neighbors adds. Interpretation of these graphs helps to correctly diagnose heart disorders and conditions. These graphs help the physicians diagnose a real-time emergency, such as acute myocardial infarction, but they can also help detect patterns that emerge over time such as sinus bradycardia or even mitral valve prolapse.

Myth 2: You Can Append Modifiers 26, TC

Reality: Although for many codes you would indicate performance of only a portion of the service by appending either modifier TC (Technical component) or 26 (Professional component), that method does not apply for ECGs.

Instead, this family of codes provides separate options depending on whether the physician performs the entire service (93000,  Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report); the technical component only (93005, Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report); or the professional component only (93010, Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

Coding tip: To choose the appropriate ECG code, you should carefully check the documentation, according to Neighbors.

For example, if in the rare event that the ED practice owns the ECG machine and performs the interpretation and report, then choose 93000. The ECG machine, supplies, interpretation and report are considered the technical and professional components of the service. However, it is not typical for this to occur in the ED setting.

93000 example: The ED physician performs the ECG in the ED, so you would report the complete component code 93000.

93005 example: When a facility provides an ECG on the patient, the facility would capture 93005, Neighbors says. The ECG machine and tracings are considered the technical component of the service.

93010 example: If the ED physician performs the interpretation and report on an ECG performed in a facility only, then you would report 93010. This is considered the professional component of the service. Reminder: The facility owns the ECG machine and tracing, so the physician only reports the professional component of this service.

Myth 3: The rhythm ECG codes are the same as the routine ECG codes;

Reality: You would report rhythm electrocardiogram (ECGs), which have no more than three leads, with the following codes:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report). This is the global code, which represents both the technical and professional components of the service.
• 93041 (...; tracing only without interpretation and report). If you perform only the technical component, of the service, you would report this code.
• 93042 (..., 1-3 leads; interpretation and report only). If you perform only the professional component of the service only, then you would report this code.

You should report 93040 through 93042 when the following criteria are met, according to CPT^®:

• There must be a specific order for the ECG or rhythm strip.
• The order for the exam must have been triggered by an event, like a sign or symptom
• The physician uses the rhythm strip to help diagnose the presence or absence of an arrhythmia.
• A separate signed, written, and retrievable report should be a component of the medical record.
• The documentation in the patient’s medical record should support the medical necessity for the ECG or rhythm strip.