Primary Care Coding Alert

When family physicians (FPs) order electrocardiograms (ECG), correct coding depends on where the test was conducted and how the results were interpreted.

Three codes describe routine ECGs:

93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report

93005 tracing only, without interpretation and report

93010 interpretation and report only

In rare instances when the practice doesnt own an ECG machine, the patient will be sent to the hospital for the test. In this case, the FP is not allowed to report the technical code, 93005. Family practice coders should report only 93010, if the FP personally interpreted the results. However, if a member of the hospital staff (e.g., a cardiologist) read the tracing and provided a report, the FP would not be allowed to bill either code.

On the other hand, most offices own an ECG machine and conduct the test themselves. When both the tracing and the interpretation and report are done, coders would report the global code, 93000.

FPs Must Document Their Own Comments

Documentation becomes an issue, however, when the physician uses ECG equipment that provides a machine-generated interpretation. For instance, the trace tape will include a readout that states arterial fibrillation or test normal. To bill for either the global or the interpretation code, the FPs must prove that their time and skills were used in the interpretation, and that they did not rely solely on the mechanical results.

Its tempting for a physician to sign off on the notation generated by the equipment, admits Dari Bonner, CPC, CPC-H, CCS-P, president/owner, Xact Coding & Reimbursement Inc., in Port St. Lucie, Fla. But that is not adequate. I recommend that family physicians strike through the readout, and write their own comments. These comments may support the mechanical interpretation, but should expand on the findings. Relying on the equipments output falls within the technical component of the test and, thus, no separately reported interpretation or report is justified.

The date of service for the interpretation should be reported as the date when the test was read not the date that the test was conducted. While this is the standard accepted by most Medicare carriers and commercial payers, family practices should confirm this policy and follow relevant guidelines.

Interpretation is Not Medical Decision-making

Mistakes are often made, Bonner says, when physicians count the ECG interpretation as part of the medical decision-making component of an E/M service, as well as billing either 93000 or 93010.

For instance, a physician orders the technical component of the ECG done at the hospital. He then interprets the tracing and provides a report during a follow-up visit with the patient. The FP cannot bill 93010 and use the data to support a higher level of decision-making to determine the level of the E/M service.

CPT states, the actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services.

Document Reasons for ECG Carefully

Problems also arise when physicians are lax about documenting orders for an ECG, says Michelle Ashby, CRNP, who practices with The Heart Group in Lancaster, Pa. This frequently causes denials. There are specific diagnosis codes that support the medical necessity for an ECG. But too often, the physician will quickly order an ECG and not clearly state why it needs to be done.

Ashby recommends that FP coders review the list of ICD-9 codes that their carriers accept for ECGs.

Among the acceptable diagnoses are:

393 chronic rheumatic pericarditis

396.0-396.9 diseases of mitral and aortic valves

402.00-402.91 hypertensive heart disease

427.0-427.9 cardiac dysrhythmias

786.05 shortness of breath

786.50-786.59 chest pain

789.00-789.09 abdominal pain