ED Coding and Reimbursement Alert

Question: We got a denial from an insurance company for an EKG interpretation (93010) that was billed with critical care (99291). Their appeal denial letter said "…the CPT^® book states that ECG’s are included in the critical care code. Therefore we will not process any additional payment for these claims." Is this correct?

Texas Subscriber

Answer: No, it is not. CPT^® says the following:

"The following services are included in reporting critical care when performed during the critical period by the physician(s) providing critical care: the interpretation of cardiac output measurements (93561, 93562), chest x-rays (71010, 71015, 71020), blood gases blood draw for specimen (HCPCS G0001), information data stored in computers (e.g., ECGs, blood pressures, hematologic data [99090]), gastric intubation (91105), pulse oximetry (94760, 94762), temporary transvenous pacing (92953), ventilator management ( 94656, 94657, 94660, 94662), and vascular access procedures (36000, 36410, 36600).

They are focusing on the section that states "Information data stored in computers (e.g., ECGs, blood pressures, hematologic data)…" without understanding the full paragraph. The CPT^® statement lists specific CPT^® codes that are included in Critical Care.

"Information data stored in computers (e.g., ECGs, blood pressures, hematologic data [CPT^® 99090])", means you cannot report CPT^® code 99090.

Code 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) is not listed as included. CPT^® and CMS both agree that it can be coded in addition to 99291.