Primary Care Coding Alert

Regardless of ZIP code list, use component codes or face denials If your practice falls under the alphabet soup of an RHC, HPSA and/or a PSA, your ECG and x-ray service payment depends on submitting component codes.
 
The April 2005 Family Practice Coding Alert discussed ECG filing rules for family physician coders whose practices fall in a healthcare-professional or physician scarcity area (HPSA/PSA). The piece sparked numerous questions that our experts field below. 1. The ECG Reporting Rules Apply to RHCs "I have been told that if your office is a Rural Health Clinic (RHC), you don't have to follow the HPSA and PSA ECG coding policies," says Ronda Tews, CPC, CCP, coding and compliance manager at St. John's Hospital in Springfield, Mo. "Can you verify this?" she asks.
 
Although an RHC won't receive diagnostic test bonus payment, you must still follow the same coding guidelines. "If you are an RHC, you must always file ECG and x-ray services with the component codes," says Ron L. Nelson, PA-C, president of Health Services Associates in Fremont, Mich. 2. Reimbursement Necessitates Component Billing  HPSAs, PSAs and RHCs, however, must use diagnostic test component codes, but for different reasons.
  Scarcity-area ECG bonus payment hinges on separate reporting. CMS will only pay the HPSA and PSA bonus on the professional component.
 
Example: When a coder whose practice falls in an HPSA and/or PSA approved ZIP code reports a global ECG service, she must split out the services. For the technical component, she would use 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report). She would report the professional component as 93010 (... interpretation and report only). The carrier will reimburse the professional component (93010) an extra 5, 10 or 15 percent, depending on the group's classification.
  RHC reimbursement depends on service. In an RHC, the fiscal intermediary pays for Part A services, and the Medicare carrier covers Part B services. "The technical component of an ECG or x-ray service is a Part B service, and the professional component is an RHC service as long as an RHC physician or nonphysician practitioner performs the service," says Nelson, who is also the co-founder and first president of the National Association of Rural Health Clinics.
 
Bottom line: An RHC coder must also break out diagnostic test services. For instance, you would report an RHC-performed ECG as 93005 (technical) to Part B and 93010 (professional) to the FI. 3. RHC WTM Won't Net Additional Pay As an HPSA, PSA and/or RHC, you must also separately bill Welcome to Medicare ECG-related services. Instead of reporting the global code G0366 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, performed as a component of the [...]