You Be the Coder:
EKG and X-Ray Interpretations
Published on Sun Dec 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: What should I check to make sure I have the documentation to submit an EKG or x-ray claim for the professional component of these interpretations done in the ED?
Utah Subscriber
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Answer: Documentation for EKG and x-ray interpretations varies according to guidelines, but strategically you want to prove that your emergency physician did professionally read EKGs and x-rays and used the interpretation to diagnose and treat patients.
CPT does not clearly state a documentation standard other than "separately distinctly identifiable, signed written report," but Medicare differentiates between "review" and "interpretation and report" and stipulates requirements.
You need to ask private payers for their guidelines. For payer policies that have no guidelines, you could consider "whether it may be more efficient and beneficial" to document according to CMS' guidelines, states information found in the "X-ray and EKG FAQ" section of the Web site for the American College of Emergency Physicians. At the very least, clinically relevant information should be documented.
To code and bill for an emergency physician's EKG and x-ray interpretations in the ED, you should meet the following provisions, according to information on the ACEP Web site and Robert A. LaFleur, MD, FACEP, president of Medical Management Specialists in Grand Rapids, Mich.:
Your claim includes a complete written report similar to what a specialist would prepare and consistent with the service rendered.
Your submitted interpretation and report address findings, relevant clinical issues, and comparative data when available.
Your claim includes a statement from the ED physician indicating that he's doing the interpretation, and not simply reviewing the interpretation of the radiologist or cardiologist, La Fleur says.
For EKGs, you should also include references to rate, rhythm, presence or absence of infarct/ischemia, and comparisons to old EKGs, La Fleur says.
A computer-generated report that has been modified and signed is also acceptable, he says. Individual carriers might have other standards, states the Web information on ACEP, but you can count on "ECG normal" inviting denials. The ECG interpretation need not be recorded on a piece of paper that's separate from the ED's treatment records, but local Medicare carriers may have independently more restrictive rules, the ACEP Web site warns.
For x-rays, the interpretation and report should include, in addition to the above provisions, a description of the procedure and materials, any limitations, and a clinical impression, conclusion or diagnosis, suggests the American College of Radiology Standard for Communication, Diagnostic Radiology. Note that CMS has not adopted these specific suggestions, the ACEP Web site states.
X-rays should also include a general description of the study with a more detailed discussion of positive or pertinent negatives, La Fleur says. He says that a sufficient description would read, for example: "Three-view study of the ankle was done for a patient with a history of injury and the inability to bear weight. There is soft-tissue swelling over the lateral malleolus with an associated nondisplaced spiral fracture of the distal fibula. The ankle mortise is still intact."
"Some may think this is too much information," La Fleur says. "But what is clear is that a simple 'positive' or 'negative' is not enough." |
