ED Coding and Reimbursement Alert

Question: Is it appropriate to bill for an electrocardiogram interpretation and also count the service as part of the level of evaluation and management? For example, we would give one point for ordering the test and two points for interpreting it.

New Jersey Subscriber

Answer: Both the CMS documentation guidelines and the Marshfield Clinic score sheet differentiate between "points" you assign for the review of a diagnostic test (as part of the "amount and complexity of data reviewed" category of medical decision-making) and the preparation of the separately billable written interpretive report that would be reported with its own code.

If the physician actually performs both services, you can count the separate services in both places. CPT clearly designates that the preparation of a written diagnostic interpretive report is not included in the E/M service. As far as counting all three points, you can count both the independent visualization of the tracing and the decision to order the test from the medicine section. If in doubt, check with the specific payer for an opinion.