ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the ED physician performed an evaluation and management (E/M) service for a patient that was complaining of chest pains. There was medical decision making (MDM) of moderate complexity along with a detailed history. The physician then ordered a 12-lead electrocardiogram (ECG), but only performed the interpretation and report. Final diagnosis was pleurodynia. Should I report 93000 with modifier 52 appended?

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Answer: No, you should instead report 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) for the ECG with 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity...) for the E/M. Don’t forget to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99284 to show that a significant, separately identifiable E/M preceded the ECG. Also, append R07.81 (Pleurodynia) to 93010 and 99284 to account for the patient’s chest pain.

Explanation: Since a code already exists for when a physician only performs the interpretation and report — 93010 — you shouldn’t report 93000 with modifier 52 (Reduced services). You would use modifier 52 in instances where the actual service in the code descriptor is reduced; for example, if the physician couldn’t complete a 12-lead ECG with interpretation and report for some reason, you might report 93000 with modifier 52 appended. Remember in the ED, which is a facility setting, the hospital typically owns the equipment and pays the tech to perform the EKG, so those costs are paid on the facility side. Only the interpretation and report code 93010 should be reported by the emergency physician.