Primary Care Coding Alert

Know what’s at the heart of coding these critical tests.

If you have questions about electrocardiograms (ECGs) — those important tests your provider frequently administers to patients to determine if there are any irregularities or abnormalities in the patient’s heart activity — you’ve come to the right place.

That’s because we’ve assembled six of the most critical questions coders frequently ask about how to code the tests correctly and when they can, or cannot, be coded with other services your physician provides. We’ve also added a generous helping of expert opinion to help you keep it all straight.

What’s the Difference Between an EKG and an ECG?

This is a common question, especially for new coders. The answer is simple: they are different abbreviations for the same procedure.

Which Codes Do I Use for ECGs?

There are two primary CPT^_® code series for 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);

and

• 93040 (Rhythm ECG, 1-3 leads; with interpretation and report);
• 93041 (… tracing only without interpretation and report); and
• 93042 (… interpretation and report only).

Each series is divided into three codes: one comprehensive code for both the technical (tracing) and professional (interpretation and report) components, (93000, 93040); one for the technical component only (93005, 93041); and one for interpretation and report (professional component) only (93010, 93042).

Coding caution 1: Generally speaking, you would use the comprehensive codes (93000, 93040) if your provider conducts the ECG on a machine owned by your practice and interprets the results themselves. If you send a patient to another facility for the ECG tracing, you cannot bill for the technical component (93005, 93041).

What’s the Difference Between 93000-93010 and 93040-93042?

Aside from the obvious difference regarding the number of leads as defined by the code descriptors, there are two big differences between the way the tests are conducted and when you would conduct them.

First, “the 93000-93010 series is for electrocardiograms with 12 leads to record the electrical activity of the heart, normally while the patient is in a lying down or prone position. The 93040-93042 is similar, but one to three leads are used and the patient is monitored over a specified period of time to get a reading of the heart’s currents while the patient is active,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Second, “codes 93040-93042 ‘are appropriate when an order for the test is triggered by an event, the rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is generated’ according to CPT^®,” notes Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Can I Use Modifiers TC and 26 With 93000-93010 and 93040-93042?

No. You cannot use either TC (Technical Component) or 26 (Professional Component) with either code series. That’s because the codes specify when they involve either the technical component and/or the professional component — the interpretation and report — making use of the modifiers unnecessary.

Can I Report Both 93000-93010 and 93040-93042?

There are no CPT^® guidelines prohibiting reporting both services during the same encounter. The same is also true when we look to the National Correct Coding Initiative (NCCI) edits involving the pairs. “When 93000-93010 are the column 1 codes, 93040-93042 are bundled as column 2 codes,” Falbo notes. “However, NCCI has assigned a modifier indicator of one to the edit pairs, meaning that you can unbundle the services with an NCCI-associated modifier such as modifier 59 [Distinct procedural service] or modifier XU [Unusual non-overlapping service],” Falbo continues.

Coding caution 2: “The need for both tests has to be clearly documented and medically necessary,” notes Johnson. “Billing both codes will also be payer-specific,” Falbo adds.

What Services Cannot Be Reported With 93040-93042?

CPT^® instructs you not to report 93040-93042 with programming device evaluation codes 93260 and 93279-93289, or with interrogation device evaluation (evaluation of implantable devices such as cardiac pacemakers or implantable defibrillators) codes 93261, 93291-93296, or 93298.

Can ECGs Be Billed for Both Screening and Diagnostic Purposes?

“Based on Medicare local and national coverage determinations [LCDs and NCDs], generally a medical condition is required to meet medical necessity, though they will allow ECGs for preprocedural examinations,” notes Johnson. However, “other carriers’ policies may vary, so make sure that you review carrier policies for instructions,” Johnson cautions.

Coding caution 3: “While Medicare typically reimburses diagnostic ECGs, they also cover screening ECGs as part of their initial preventive physical exams [IPPEs, also known as “Welcome to Medicare” visits],” Falbo notes (see www.medicare.gov/coverage/ekg-or-ecg-screenings).

This means you can bill an ECG along with G0402 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment) for the IPPE though you will have to use the corresponding HCPCS codes for the test, interpretation, and report:

• G0403 (Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report)
• G0404 (Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination)
• G0405 (Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination).