ED Coding and Reimbursement Alert

Hint: You may need to count leads before you can select the right code.

Reporting ECGs (electrocardiograms) can be a challenge. For example, you must check the medical documentation to see which part of the ECG service your ED provider performed. You must also know if the procedure was a routine or a rhythm ECG, and sometimes you’ll have to know how many leads were used.

To ensure that you code your electrocardiograms correctly, consider a few quick tips that will spotlight the right way to report ECGs.

Tip 1: Understand What Happens During ECG

An ECG, also known as an EKG, records the electrical activity of a patient’s heart at rest.

The Sinoatrial (SA) Node, which located in the right atrium, sends electrical impulses to the heart muscles, which contract resulting in systole. When the provider performs a 12-lead ECG, they use 12 electrodes placed on the skin over different regions of the patient’s body (the limbs and chest).

These electrodes record the electrical activities of the heart, and the recordings are put into a graphic format. When the provider interprets the graphs, they can diagnose heart disorders and conditions such as myocardial infarctions (MIs), sinus bradycardia, and mitral valve prolapse.

Don’t miss: “There are usually distinct reasons for performing a 12 lead ECG versus a 1-3 lead ECG,” says Robin Peterson, CPC, CPMA, manager of professional coding with Pinnacle Integrated Coding Solutions, LLC. “A 12 lead ECG provides a complete 3-dimensional look at the heart’s electrical activity and is considered the gold standard.

A 12 lead ECG helps identify things like myocardial ischemia and myocardial infarction, but also gives a picture of any arrhythmia the patient may be experiencing, Peterson added. A 1-3 lead EKG focusses on the heart rhythm and is useful for identification of things like heart block and tachyarrhythmias.

Tip 2: Turn to These Codes for Routine ECGs

If your physician performs a routine ECG with at least 12 leads, you should look to the following codes:

• 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). Note: You should use code 93000 when your provider performs an ECG at their practice. For instance, this would apply if an urgent care provider owns the ECG machine and performs the interpretation and report.
• 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report). Note: A facility reports code 93005 when it provides an ECG for a patient. The ECG machine and tracings are considered the technical component of the 93005 service.
• 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only). Note: You should report 93010 if your provider performs only the interpretation and report of an ECG in a facility. In this case, 93010 is the professional component of the ECG, and since the facility owns the ECG machine and tracing, your physician would only report the professional component.

Tip 3: Rely on 93040-93042 for Rhythm ECGs

If your ED physician performs a rhythm ECG, you should look to the following codes:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report). Note: You should report code 93040 for both the professional and technical components of a rhythm ECG service. In this case, your provider must own the machine and supplies if you report this code.
• 93041 (...; tracing only without interpretation and report). Note: You should report code 93041 to capture the technical component only of a rhythm ECG service.
• 93042 (..., 1-3 leads; interpretation and report only). Note: You should report 93042 to capture the professional component only of the rhythm ECG service.

Don’t miss: Always remember that rhythm ECGs have no more than three leads.

Follow these rules: CPT^® gives you these specific rules to follow when reporting rhythm ECGs:

• Rule 1: There should be an order for the ECG or rhythm strip.
• Rule 2: The order for the exam should be triggered by an event, like a sign or symptom.
• Rule 3: The provider uses the rhythm strip to help diagnose the presence or absence of an arrhythmia.
• Rule 4: A separate signed, written, and retrievable report must follow the ECG order.
• Rule 5: The documentation in the patient’s medical record should support the medical necessity for the ECG or rhythm strip.

Caution: You should never report codes 93040-93042 for the review of telemetry monitor strips taken from a monitoring system, per the CPT^® guidelines.

Tip 4: Dig Into Routine ECG Scenario

Put together everything you learned above and test your knowledge about how to report a routine ECG.

Example: The provider performs a routine ECG with 12 leads, and also performs the interpretation and report.

Solution: You should report 93000 in this case.

Tip 5: Discover Rhythm ECG Example

Check out this rhythm ECG example to make sure you know how to report these codes appropriately: The ED provider performed both the professional and technical components of a patient’s one-lead rhythm ECG. The physician’s order for the ECG supported the diagnosis of unspecified chest pain as the triggering event. The provider used the rhythm strip to help diagnose the presence or absence of an arrhythmia. The medical documentation demonstrated the need for the physician to evaluate the presence or absence of an arrhythmia. The provider’s separate signed, written, and retrievable report followed their ECG order.

Solution: You should report 93040 (Rhythm ECG, 1-3 leads; with interpretation and report) for the ECG. You should report R07.9 (Chest pain, unspecified) as the ICD-10-CM code.