ED Coding and Reimbursement Alert

Question: If the physician hasn't indicated the EKG results in his final diagnosis, should we still code the findings? He wrote a complete interpretation on the strip. He says yes, because usually he has another diagnosis to justify the EKG.


Massachusetts Subscriber

Answer: For you to report findings from the electrocardiogram, the physician must document the findings as a final diagnosis. Choosing a diagnosis yourself based on the patient's test results--even when that diagnosis seems obvious--is inappropriate (and possibly fraudulent) coding.

CMS describes its guidelines for this issue in Transmittal AB-01-144 (Sept. 26, 2001), in which the agency states that a physician must confirm a diagnosis based on the test results. If the test results are normal or non-diagnostic, you should code the signs or symptoms that were the reason for the test.

Similarly, the ICD-9 coding guidelines for diagnostic testing instruct you not to -interpret- what a study says, but rather to rely on the physician's stated diagnosis. If the EKG findings seem like an important component of the case--and may play a role in substantiating the medical necessity for the visit--you should query the physician regarding the diagnosis.