Pain Management Coding Alert

Question: I am unsure about some of the electrocardiogram (EKG or ECG) reporting rules. Could you please explain the rhythm ECG CPT^® guidelines?

Oregon Subscriber

Answer: You would report rhythm EKGs, which have no more than three leads, with the following codes:

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report). This is the global code, which represents both the technical and professional components of the service.
• 93041 (...; tracing only without interpretation and report). If the provider performs only the technical component, of the service, you would report this code. This is rarely coded by ProFee, Facilities normally capture this CPT^® code.
• 93042 (..., 1-3 leads; interpretation and report only). If the provider performs the professional component of the service only, then you would report this code.

You should report 93040 through 93042 when the following criteria are met, according to CPT^®:

• There must bea specific order for the EKG or rhythm strip.
• The order for the exam must have been triggered by an event, like a sign or symptom
• The provider uses the rhythm strip to help diagnose the presence or absence of an arrhythmia.
• A separate signed, written, and retrievable report must follow the EKG order.
• The documentation in the patient's medical record should support the medical necessity for the EKG or rhythm strip.

Don’t miss:  You should not report 93040 through 93042 to indicate the review of the telemetry monitor strips taken from a monitoring system, per CPT^®. The provider’s review of the telemetry data is considered part of the evaluation and management (E/M) service, so it is not a separately reportable service.

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