ED Coding and Reimbursement Alert

Answer: You may have difficulty recovering payment for both 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) and 93042 (Rhythm ECG, one to three leads; interpretation and report only) if they are from the same ECG tracing. You can bill for both tests as long as they are medically necessary. CMS says only one interpretation of an ECG will be paid for an ED patient. The agency advises "hospitals that if they allow a physician to perform and bill for a medically necessary service (the interpretation and report) in an ED and another physician performs and bills for the same service, the Medicare carrier will pay for the reading that was contemporaneous and on which the patient's diagnosis and treatment was based." Usually, this would be the ED physician.

According to CMS, you can receive reimbursement for second interpretations under unusual circumstances, such as questionable findings.

Be sure to include complete documentation when billing for the physician's ECG interpretation. If a patient presents to the ED with chest pain and the doctor suspects a cardiac problem, the ED physician will likely order an ECG and interpret the results to see if the problem is cardiac-related.

Medicare does not want to pay for two interpretations of the same test, which might be the case if the local cardiologist reads your ED cardiograms. If the cardiologist is reporting 93010, the ED doctor cannot report 93042 to get paid for his interpretation of the same tracing. For you to bill for 93042, the patient needs to be on a cardiac monitor and require evaluation of the rate and rhythm separately from the 12-lead ECG.