ED Coding and Reimbursement Alert

To ensure proper diagnosis coding for electrocardiography, you need to remember two things: specificity and medical necessity.

ECGs (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;) are some of the most common diagnostic tests performed by ED physicians and cardiologists in the ED.

During the noninvasive procedure, a patient has electrodes placed on his or her chest, arms and legs to produce an electrical recording of the heart. Technically speaking, the ECG is a graphic tracing of the electrical activity caused by the impulses that travel through the heart that determine the heart's rate and rhythm as detected at the body surface. ECGs are used in the diagnosis of disorders of cardiac rhythm, anatomy, coronary blood flow, myocardial function, and symptoms related to such disorders. They are also used as an adjunct to the diagnosis of certain drug toxicities and metabolic disorders. Three Steps to Specificity Proper payment for ECGs depends on whether you establish a credible medical necessity for the procedure by applying the correct diagnosis code. These codes tell the payer why the ED physician performed the ECG. And increasingly, carriers are denying payment if the ICD-9 codes are not specific enough. You can ensure you are coding to the highest possible level of specificity by following a sound coding and assessment process, which has three steps:

1. Gather complete information. When you are translating the physician's encounter information into codes, you need complete information. You may not have enough information to code the services based on the ED physician's written notes. For example, if the doctor writes "heart failure" in the patient's record you may need more information. Heart failure (428) is an incomplete (truncated) code and will be denied because you did not carry it out to the highest degree of specificity. You need the data that will help you determine the type of heart failure and whether it is a confirmed or "rule-out" diagnosis.

Congestive heart failure (428.0) is a more specific code and will allow the EKG to be paid. A rule-out diagnosis may be clinically important to have in the chart, but it will not justify the procedure or service from the insurer's perspective, and it cannot be coded directly. Consequently, you will have to seek out more information on the specific symptoms from the patient's chart or by asking the physician. Specific diagnosis coding requires clear access to all the necessary information. And, due to the nature of the clinical interaction in the ED, it is perfectly acceptable and common to use symptom-based codes. Codes such as unspecified chest pain (786.50) or shortness of [...]