ED Coding and Reimbursement Alert

Question: Can nurse practitioners (NPs) and physician assistants (PAs) charge for interpreting EKGs using 93010 (electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) or for reading EKG rhythm strips using 93042 (rhythm ECG, one to three leads; interpretation and report only)?

Nancy Ryder
RN Medical Coding Manager at ProBill
Huntington, W.V.

Answer: Yes. PAs and NPs can bill for 93010 and 93042 under their own provider number per HCFAs federal guidelines. According to Medicare, PAs and NPs can bill any service they provide. This also applies to private payers, if they recognize these midlevel providers. However, NPs and PAs will be held to the same reporting, billing and documentation standards as physicians. According to HCFA guidelines, only one interpretation of an EKG will be paid per ED patient. That is important to remember, because in some situations the cardiologist as well as ED staff read EKGs, but only one read will be reimbursed. For more information on billing for EKGs in the ED, please see Written Report Reduces Denials of Rhythm Strip Interpretation in the January 2000 ED Coding Alert.