ED Coding and Reimbursement Alert

Question: Our ED physician conducted a 12-lead electrocardiogram (EKG) on a patient diagnosed with stenosis in the aortic and mitral valves. What would be the correct coding for this scenario? Specifically, how many ICD-9 codes should I report for the patient?


Arkansas Subscriber

Answer: You-ll use one diagnosis code to represent the stenosis in both valves. When patients have stenosis (or another affliction) in the mitral and aortic valves, you should choose a code from the 396.x series (Diseases of mitral and aortic valves) to identify both conditions.

Aortic stenosis does have its own ICD-9 code, 424.1 (Aortic valve disorders). However, the exclusions section for 424.1 states that the diagnosis does not include -that of unspecified cause but with mention of diseases of mitral valve (396.0-396.9).-

ICD-9 coding: The proper ICD-9 code for your claim is 396.0 (Mitral valve stenosis and aortic valve stenosis).

CPT coding: Choose from one of these ECG codes, depending on the specifics of the encounter:

- 93000--Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

- 93005--... tracing only, without interpretation and report

- 93010-- ... interpretation and report.

In the ED setting, you will likely report 93010 for the professional component of the interpretation and report.

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of MRSI, an ED coding and billing company in Woburn, Mass.