ED Coding and Reimbursement Alert

In the December 1999 issue of ED Coding Alert (page 89-91), we detailed correct coding and documentation for use of the code 93010 (electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

In the last section of the article, we touched on whether coders should report a code for a rhythm strip interpretation (93042, rhythm ECG, one to three leads; interpretation and report only) if the physician did not completely document the interpretation of a 12-lead ECG.

This is a controversial area, as many physicians and coders believe this is a valid practice, while others feel that it is fraudulent to report a rhythm strip interpretation, if a full 12-lead interpretation were actually performed.

We consulted two emergency physicians on the differences between a rhythm ECG and 12-lead ECG and whether it is permissible to report 93042 when a full ECG is performed.

Medicare Prohibits Reporting
Both 93010 and 93042 on One ECG

Other than lack of documentation, the real problem with the rhythm strip vs. full interpretation dilemma is that emergency department (ED) physicians often report 93042 when they know that the cardiologist who is doing the overread will report CPT 93010 , says Daryl LaRusso, MD, FACEP, an emergency physician in West Virginia.

Medicare has said that they dont want to pay for two interpretations of the same test, he adds. So, if the cardiologist is reporting 93010, the ED doctor cannot report another code to get paid for your interpretation.

Some physicians and coders believe this to be a valid way to report the service, since most ED physicians rely on the rhythm strip portion of the full ECG when making the diagnosis, says John Turner, MD, FACEP, medical director for coding and documentation at TeamHealth, Inc., an emergency physician staffing company based in Knoxville, Tenn.

When you do an ECG, it has 12 leads, but down at the bottom it has three rhythm strip leads, so when I am looking for the rhythm that the patient is in, I dont look at the 12-lead portion. The little individual strip isnt long enough to tell me what the rhythm is, you have to look down at the bottom at the rhythm strip, he explains. But, Medicare has said that it doesnt want to pay for the same piece of paper (the interpretation and report) twice. Therefore, it is necessary to find out whether the hospital or cardiologist is also billing for an interpretation of the same ECG.

For Medicare payers, if you are the only one billing an interpretation from a single ECG, the physician should use 93010 if he or she performed a full interpretation and report of a 12-lead ECG, including a separate [...]