Pediatric Coding Alert

Question: After obtaining a patient and family health history and doing a physical exam focused on cardiovascular disease risk factors, a pediatrician decided to order an electrocardiogram (ECG) to further assess the patient before treating him with drugs for attention deficit hyperactivity disorder (ADHD, 314.01). How should I code the ECG?

Michigan Subscriber

Answer: You should bill the global code (93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) when your pediatrician performs and interprets an in-office ECG and documents his findings. If the patient goes to the hospital for the ECG and the pediatrician still provides the interpretation/report, bill 93010 (... interpretation and report only) for the professional component.

Codes 93000-93010 contain no global period. So according to CMS, you would not need modifier 25 (Significant, separately identifiable evaluation and management service on the same day of the procedure or other service) on the E/M service, such as 99201-99215 (Office or other outpatient visit ...) with 93000-93010. Some payers, however, may require modifier 25 on the associated E/M service.