ED Coding and Reimbursement Alert

Question: How do AMA and Medicare guidelines differ for coding an emergency physician's interpretations of an EKG?

Washington Subscriber

Answer: According to both AMA and Medicare guidelines, you need a separate, distinctly written report documenting the physician's EKG interpretation.

But Medicare requires more than just a report. You must present documentation that indicates that the physician's interpretation was additional to the report covered by the E/M codes and similar to that of a specialist in the field. E/M payment already covers EKG reviews, so Medicare will not reimburse the professional component of EKG interpretations unless you append your claim with a "complete" report.

Avoid denials by heeding the guidelines Medicare gives carriers for EKG interpretation reimbursement. A sufficient report addresses "findings, relevant clinical issues and comparative data (when available)," as defined in the Medicare Carriers Manual Part 3. Most coders interpret findings to include rate, rhythm, axis, ectopy and ischemic changes. If you note only "EKG normal" in the medical records, your report will not suffice for a separately payable interpretation.

As for CPT guidelines, they also require a separate, distinctly identifiable written report, but they do not specify criteria for what it should include.