93000 – 93010 – Hone Your ECG Coding Skills With These 3 meaningful Pointers

Grasping the effects of 93010 on new vs. established patient position could bring a reward of $58.

Whether you call them ECGs or EKGs, there are chances you will see a lot of electrocardiograms in your practice. That method that already the smallest coding errors can add up quickly. Brush up on the 93000-93010 basics with this review of the service, the code elements, and the role ECGs can play in selecting the right E/M code.

Rely on These Codes for Proper ECG Reporting

There are three codes for routine ECG:

  • 93000 – Electrocardiogram, routine ECG with at the minimum 12 leads; with interpretation and report
  • 93005 -… tracing only, without interpretation and report
  • 93010 -… interpretation and report only

Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash says, these codes describes the sets which involves placing six leads on the patient’s chest and additional leads on each extremity. The procedure “picks up and traces the path of electrical activity sent from the SA [sinoatrial] node by the heart and puts it onto paper,” Neighbors adds.

CPT Assistant (April 2004) explains that the external skin electrodes can pick up electrical current because the heart’s electrical activity generates currents that spread to the skin.

Prevent Denials With This Modifier 26 Rule

Just say no to modifier 26 (specialized part) with your ECG code, says Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Ala. Likewise, you should not append modifier TC (Technical part).

Reason: Codes 93000-93010 are already broken down into specialized and technical elements, Huey says:

  • 93000: global (specialized and technical elements)
  • 93005: tracing (technical part)
  • 93010: interpretation and report (specialized part).

In other words, if the cardiologist provides only the interpretation and report for an ECG performed at a hospital, you should go for 93010, not 93000-26.

Helpful: If you ever need a reminder about whether a code accepts modifiers 26 and TC, the Medicare physician fee schedule (MPFS) can be of help. According to the MPFS, 93000 has a PCTC (PC, TC) indicator of “4,” meaning “global test only” code. Code 93005’s PCTC indicator is “3,” which indicates “technical part only” code. And 93010’s indicator of “2” method the code is a “specialized part only.” You can search the MPFS at http://www.cms.hhs.gov/pfslookup/.

Determine Whether 93010 Patients Are ‘New’

Your cardiologist’s role in an ECG interpretation could dictate whether you select a new or established patient E/M code at the patient’s next visit.

Rationale: “An interpretation of a diagnostic test, reading an x-ray or EKG, etc., in the absence of an E/M service or other confront-to-confront service with the patient doesn’t affect the designation of a new patient,” states Medicare Claims Processing Manual, Chapter 12, Section 30.6.7 (www.cms.hhs.gov/Manuals/).

Betsy Nicoletti, MS, CPC, founder of Medical Practice Consulting in Springfield, Vt. Says, “You just need to be sure you understand the definition of a new patient.” A new patient is someone who hasn’t received specialized service from that physician (or another physician of the same specialty in the same group) during the last three years.

Medicare’s decision to no longer cover consult codes makes mastering new versus established already more vital. Your consult code choice didn’t differ based on whether a patient was new or established, but the codes you use to replace the consult might. for example, consult codes 99241-99245 specify: “Office consultation for a new or established patient…” In comparison, office/outpatient E/M codes 99201-99205 are for new patients only and 99211-99215 are for established patients only.

Payoff: If documentation supports your coding a visit before reported as a consult as a level-five E/M service, for example, knowing the difference between new and established has an impact on your pocket. The Medicare non-facility national rate for a level-five new patient visit (99205) pays $58 more than a level-five

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