Primary Care Coding Alert

Question: A patient recently came in to our practice for three separate electrocardiograms (ECGs). We have a large and very busy practice, so Dr. X performed and interpreted the first ECG, while Dr. Y conducted and interpreted the last two tests. As the procedures were the same but the doctors who performed them were different, how do we go about reporting each encounter?

New Mexico Subscriber

Answer: As both of your providers performed and interpreted the ECGs, CPT^® code 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) will apply to all three services. But you will have to be careful to distinguish each one with the use of modifiers.

The first encounter, performed by Dr. X., will not need a modifier. Dr. Y’s first ECG, however, will need modifier 77 (Repeat Procedure by Another Physician or Other Qualified Health Care Professional) to document that the procedure was conducted by a different physician. And you would attach modifier 76 (Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional) to Dr. Y’s second ECG to indicate that the same procedure was performed by the same physician twice.

Coding alert: With ECGs, you must make sure you know exactly what was done in the procedure, as you should only use 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) when your provider performed the technical component alone, while you can only document 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) when a professional only read and interpreted the ECG.

You should also note that ECGs will never take modifiers TC (Technical component) or 26 (Professional component), as the existence of 93010 precludes documenting 93000 with TC, just as the existence of 93005 avoids the necessity of reporting 93000 with modifier 26.