ED Coding and Reimbursement Alert

Question: We are reviewing guidelines for an EKG done with critical care (99291-+99292), which states that EKGs are bundled into the critical care codes. However, your article “Know What’s Included in the Critical Care Codes” (ED Coding Alert volume 24, number 1) says that EKG interpretations can be reported with critical care. Who is correct?

Kansas Subscriber

Answer: The American College of Emergency Physicians (ACEP) delved into this topic and created a frequently-asked question about it, aiming to clarify the issue. “The services associated with 12-lead ECGs (CPT^® 93000 routine ECG with 12-leads, with interpretation and report, 93005 12-lead only without interpretation and report, 93010 interpretation and report only) and Rhythm ECGs (CPT^® 93040 rhythm ECG one to three leads, with interpretation and report 93041 tracing only without interpretation and report, 93042 interpretation and report only) can be coded in addition to critical care services.”

Keep in mind, however, that certain payers will have specific policies noting which codes you can and cannot report together. For instance, the National Correct Coding Initiative (NCCI), which CMS and many other payers use, bundles 93040, 93041, and 93042 into the critical care codes. However, 93010 is not bundled.

Your best bet is to check directly with your individual payers to evaluate which codes are billable with critical care. For reference, you can find the ACEP FAQs here: www.acep.org/administration/reimbursement/reimbursement-faqs/x-ray---ekg-faq/.