ED Coding and Reimbursement Alert

Your job is to ensure your physicians get paid fairly. When you report EKG interpretations for the ED, you should be aware of the controversy surrounding diagnostic test interpretation payment and do what you can to help.

When facing EKG denials, remember that ED physicians are "entitled" to payment for initial, contemporaneous interpretations, says Susan Reese, CPC, CCP, director of coding and compliance for Mediphase in San Antonio. These interpretations contribute directly to the patient's treatment.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), however, requires a random sampling of over-reads done by cardiologists, and some facilities mandate over-reads of interpretations, she says. Cardiologists end up frequently billing for the  same claims your ED has read, and they generally are not pleased that ED physicians end up procuring the payment for over-reads they're required to do.

Let the administration figure out the logistics of pleasing both departments. Before reporting EKG codes, however, determine if your department has an official agreement not to charge EKG interpretations

If you face payment competition, speak with your cardiologists and devise an official, joint payment plan. For example, ED physicians bill for the contemporaneous readings, and the hospital offers the cardiologists a flat monthly rate for their over-reads. When Reese witnessed this type of plan, she saw few payment-related problems after its enactment.

Without a plan for who bills for contemporaneous readings, chances are you'll get paid based on how quickly you send in the claim, so code for EKGs right away. The carrier will probably pay based on whose claim arrives first yours or the cardiologists.