Internal Medicine Coding Alert

Question: Can a physician bill for an ECG
interpretation when the test is performed by a nurse at a nursing home?

Anonymous GA Subscriber

Answer: When reporting diagnostic tests, coders should remember that there is the technical componentactual performance of the testand the professional componentthe physicians interpretation of the results.

With electrocardiograms (ECGs), there are separate codes for the performance of the technical portion alone and the professional and technical components performed together. Code 93000 is for the performance of ECG with interpretation and report. Code 93005 is for the tracing only.

This is the code for the performance of the test in the nursing home and would be billed by the nursing home, says Hill. Code 93010 would be the interpretation and report only, which would be reported by the physician.

However, Hill emphasizes that the physician must keep documentation that he or she actually looked at the test and made some sort of clinical determination in order to bill for the interpretation.

Many ECG machines provide an automated printout that indicates a test result. The physicians documentation must include more than that, she adds.

The printout does have some indication of the result and interpretation, she says. The additional documentation required is often in the eye of the auditor.

Hill recommends that the physician make a separate note indicating his review of the ECG strip and his clinical observations and diagnosis. However, if it is inconvenient, documentation on the ECG strip is accepted.

I dont like writing directly on the strip because that can get lost, she says. But, you could certainly write on the strip, if you at least indicate that it was reviewed and you agreed with the above indication.