Primary Care Coding Alert

Question: Do Welcome-to-Medicare patients qualify for a screening ECG? Which codes should I use?


Texas Subscriber

Answer: Within six months of enrollment in Medicare, patients qualify for a one-time, head-to-toe screening physical exam and screening ECG.

One-time only: For this kind of screening visit, instead of flipping to a traditional ECG code such as 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), you-ll need to use one of the new G codes:

- G0366 -- Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report,  performed as a component of the initial preventive physical examination (Note: This code is equivalent to 93000.)

- G0367 -- Tracing only, without interpretation and report, performed as a component of the initial preventive physical examination (Note: This code is equivalent to 93005.)

- G0368 -- Interpretation and report only, performed  as a component of the initial preventive physical examination  (Note: This code is equivalent to 93010.)

A physician or qualified nonphysician who performs the complete ECG service, in addition to the physical, would report both G0344 (Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first six months of Medicare enrollment) and G0366, according to the Nov. 15, 2004, Federal Register. 

Remember: Medicare won't pay for G0366 and G0367 when the physician performs the services in the facility setting, the Register said.
 
The reason is that these two codes include the technical component of the test. In a facility setting, you should not report the technical component of the service, just the professional component (G0368), since it is the facility, not the physician, that is providing the technical component in this situation.