Primary Care Coding Alert

Experts reveal 4 secrets of component-ECG coding

Family physicians (FPs) don't always perform the same electrocardiogram (ECG) service - the differences in where and what they provide determine your 93000, 93005 or 93010 selection.

If an in-office machine spits out the information, and the FP issues a report, you should report the complete code 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), which pays more than $26, says Connie Apperson, a family-practice biller at Clarinda Medical Associates in Clarinda, Iowa. But deciding which code to report when your practice doesn't provide the tracing or interpret the results is more problematic.

Don't fall into the trap of using modifiers -TC (Technical component) and -26 (Professional component) on 93000, says Quinten A. Buechner, MS, MDiv, CPC, CHCO, president of ProActive Consultants in Cumberland, Wis. You should instead report 93005 (... tracing only, without interpretation and report) for the technical component and 93010 (... interpretation and report only) for the professional service.
 
Why does CPT use 93000-93010 rather than modifiers -TC and -26 for ECG component coding? When CPT developed the ECG codes many payers didn't recognize modifiers " Buechner says. To avoid insurers ignoring the modifiers and in turn rejecting claims for what would then appear as duplicate 93000 billing CPT assigned specific codes for the services. To determine when to use 93000-93010 coding experts recommend four guidelines:

1. Bill 93005 for In-Office Procedure

If your FP performs an in-office ECG without interpreting the report you should assign 93005 for the technical component Buechner says. " Code 93005 consists of the FP or his staff placing the 12 leads on the patient performing the standardization process and taking the gel off the patient at the end of the ECG " he says.

2. Use 93010 for Report Only

Sometimes the FP performs the ECG in the hospital but still issues the report. In this case bill 93010 for the professional component Apperson says.

To get the $9 for performing the professional component your FP must document that he interpreted the ECG's printout Buechner says. Because the technical component (93005) includes the machine's report the FP must show that he did more than look at the printout.

Medicare and other carriers expect the FP to write report interpretations on the machine's 8 x 11 sheet or strip report Buechner says. "Proper documentation includes stating why the doctor agrees or disagrees with the machine's description and signing and dating the report " he says.

For instance the FP might write: Because the equipment needs recalibrating I disagree with the machine's diagnosis. "Notations such as these indicate that the physician did more than just look at the machine's report " Buechner says.

3. Assign 93000 for Procedure and Report

 You should bill the global code (93000) when your FP performs the ECG and documents his findings Apperson says. "We've had no problems with Medicare and other insurers reimbursing us for ECGs provided we follow these rules " she says.

4. Employ Other-Physician Interpretations Options

 Some FPs do not feel comfortable reading the ECG reports and hire a cardiologist or internist to interpret the printout. In this instance each doctor should bill for his own role Buechner says. For example an FP performs an ECG in his office and has a cardiologist interpret the report. In this case you should report 93005 for the FP and the cardiologist's coder should bill 93010.

You could encounter reimbursement problems from each physician billing for the service he provides Buechner says. "Patients who never saw the cardiologist may refuse to pay for a bill from a doctor that they never saw."
 
Here's how to avoid this problem: When billing commercial carriers create a contractual agreement with the interpreter. The FP could pay the internist or cardiologist a salary or make an independent contract arrangement with them Buechner says. "That way the FP's practice could bill for the global code " he says.

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