Primary Care Coding Alert

Question: As an HPSA, must we submit component codes when we provide a complete ECG?


Tennessee Subscriber

Answer: Although you now have to break down the electrocardiogram (ECG) service, this extra work is about to end.

Family physicians billing Medicare carriers for the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) bonuses must submit the component codes for ECGs and x-rays even when the practice furnishes the complete service. CMS made this a coding requirement to properly allocate bonus payments on only the professional portions.

New way: Starting July 1, you should instead use the global ECG code (such as 93000, Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or x-ray code (such as 71020, Radiologic examination, chest, two views, frontal and lateral). Change Request 5015 -will allow physicians to submit global services and receive the HPSA and PSA bonus without having to submit the professional component and technical component (PC/TC) separately,- CMS explains in MLN Matters Number: MM5015.

How it works: A coder in an HPSA or PSA bonus payment area submits a claim for a complete ECG. Until June 30, she should split out the service using:

- 93005--Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report

- 93010--... interpretation and report only.

For claims dated July 1 and later, she should report the global code 93000.

Important: The change will apply to all professional component/technical component-4 codes except for procedure code 93015 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report). Continue to use separate component codes when reporting cardiovascular stress tests.