ED Coding and Reimbursement Alert

Remember when to report an E/M service instead of EKG code

Patients that report to the ED for an electrocardiogram (EKG or ECG) can create a coding quandary. Namely, how does the ED coder report their physician’s work with the patient? Can they use the EKG CPT^® codes or do they need to go another route?

The answer is … it depends. Your coding in these situations is scenario-dependent, so you need to be ready to code a couple of different ways depending on encounter specifics.

Help’s here: We rounded up some experts to see what they had to say about what codes you should use in which situations to correctly code EKG patients each time.

Remember These Codes, and This Modifier

If a patient reports to the ED and receives an EKG, there are two code sets you should be focusing on:

• ED evaluation and management (E/M) codes 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making)
• EKG codes 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), 93005 (… tracing only, without interpretation and report), and 93010 (… interpretation and report only)

Why it matters: Regardless of the situation surrounding the encounter, these are the codes you’ll need to focus on for your EKG coding.

Do This if Cardiologist Interprets EKG

When your ED physician orders an EKG, a lot will depend on what other physicians are on the clock at the hospital — specifically cardiologists.

Sometimes in the ED setting, “hospitals will have contracts with a cardiologist to perform the official interpretation for the EKGs and allow them to bill for the interpretation,” explains Rae Jimenez, CPC, CDEO, CIC, CPB, CPMA, CPPM, CCS, chief product officer at AAPC and member of the CPT^® Editorial Panel. “Insurance will only cover one interpretation for an EKG.”

So when the facility’s cardiologist performs (and bills for) the EKG interpretation, “ED physicians will usually include the work of the interpretation they perform in the MDM [medical decision making] since they can’t bill for it separately,” confirms Jimenez.

If an ED physician orders an EKG in their workup of a patient but doesn’t bill for it, they can get credit for it under the “Amount and/or Complexity of Data to Be Reviewed and Analyzed” column in the MDM table, explains Jill Young, CPC, CEDC, CIMC, owner of Young Medical Consulting in East Lansing, Michigan.

When your ED physician does perform the “independent interpretation of test,” the claim must be accompanied by a report documenting your findings. Keep in mind that the report detail to count the EKG toward the MDM is much less than what is required for the separately billable interpretation, which has a higher standard of documentation.