Bernadette10
Guru
Is 93010 for this preop screening EKG billable? A patient had a cold knife conization of the cervix 57520 (90-day global) by an Ob/Gyn. The Ob/Gyn ordered a screening preop EKG which was done on the same date that was over-read by a cardiologist. Is the interpretation by the cardiologist billable as 93010? The EKG finding was nonspecific T-wave abnormality. Would the diagnosis be Z01.810 and R94.31?
Here's a reference I found, but is this only for Medicare, or is it also for Medicaid and all insurance that follows Medicare rules?
https://medicarepaymentandreimbursement.com/2011/05/electrocardiogram-ecg-or-ekg-cpt-93000.html
Whereas there is no argument that the ECG is an important diagnostic tool, coverage cannot be provided for ECGs performed when there is no clear relationship to treatment or diagnosis of a specific disease or injury, or a sign, symptom or complaint is apparent. Payment for the services affected by this LCD must be made only for those services that directly contribute to the diagnosis and treatment of an individual patient. Services provided that do not directly contribute to the diagnosis or treatment of an individual patient (such as ECGs that are performed routinely upon admission to a facility or routinely performed prior to surgery) are not medically necessary and will be denied when billed and coded appropriately.
There's also this from the guidelines for outpatient services, but does this apply to screening and diagnostic tests? It sounds like it's for consultations.
Diagnostic Coding and Reporting Guidelines for Outpatient Services
Patients receiving preoperative evaluations only
For patients receiving preoperative evaluations only, sequence first a code from subcategory Z01.81, Encounter for pre-procedural examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation.
Here's a reference I found, but is this only for Medicare, or is it also for Medicaid and all insurance that follows Medicare rules?
https://medicarepaymentandreimbursement.com/2011/05/electrocardiogram-ecg-or-ekg-cpt-93000.html
Whereas there is no argument that the ECG is an important diagnostic tool, coverage cannot be provided for ECGs performed when there is no clear relationship to treatment or diagnosis of a specific disease or injury, or a sign, symptom or complaint is apparent. Payment for the services affected by this LCD must be made only for those services that directly contribute to the diagnosis and treatment of an individual patient. Services provided that do not directly contribute to the diagnosis or treatment of an individual patient (such as ECGs that are performed routinely upon admission to a facility or routinely performed prior to surgery) are not medically necessary and will be denied when billed and coded appropriately.
There's also this from the guidelines for outpatient services, but does this apply to screening and diagnostic tests? It sounds like it's for consultations.
Diagnostic Coding and Reporting Guidelines for Outpatient Services
Patients receiving preoperative evaluations only
For patients receiving preoperative evaluations only, sequence first a code from subcategory Z01.81, Encounter for pre-procedural examinations, to describe the pre-op consultations. Assign a code for the condition to describe the reason for the surgery as an additional diagnosis. Code also any findings related to the pre-op evaluation.