93000 – 93010 – Hone Your ECG Coding Skills With These 3 Key Tips

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

Whether you call them ECG or EKG, you will likely see a lot of EKGs in your office. That means even the smallest coding errors can add up quickly. Go over the basics of the 93000-93010 with this review of the service, the code components, and the role that ECGs can play in selecting the E / M code.

Rely on these codes for proper ECG reports

There are three codes for the ECG routine:

• 93000 – Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
• 93005 -… trace only, no interpretation or reporting
• 93010 -… only interpretation and report

Christina Neighbors, MA, CPC, CCC, ACS-CA, Charge Capture Reconciliation Specialist and Coder at St. Joseph Heart & Vascular Center in Tacoma, says Wash, these codes describe services that involve placing six wires on the chest of the patient and additional cables on each limb. The procedure “collects and traces the route of electrical activity sent from the SA [sinoatrial] node through the heart and puts it on paper, “adds Neighbors.

CPT Assistant (April 2004) explains that the external electrodes of the skin can capture electrical current because the electrical activity of the heart generates currents that propagate to the skin.

Avoid denials with this modifier 26 rule

Just say no to modifier 26 (Professional Component) with your ECG codesays Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Alabama. Similarly, you should not add modify TC (technical component).

Reason: Codes 93000-93010 are already divided into professional and technical components, says Huey:

• 93000: global (professional and technical components)
• 93005: trace (technical component)
• 93010: interpretation and report (professional component).

In other words, if the cardiologist provides only the interpretation and report of an ECG performed in a hospital, they should choose 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 help. According to the MPFS, 93000 has a PCTC (PC, TC) flag of “4”, which stands for “global test only” code. The PCTC indicator for code 93005 is “3”, which indicates the “technical component only” code. And the “2” indicator on the 93010 means that the code is a “professional component only”. You can find the MPFS at http://www.cms.hhs.gov/pfslookup/.

Determine if 93,010 patients are ‘new’

The role of your cardiologist in interpreting an ECG may dictate whether you select a new or established patient E / M code at the next patient visit.

Fundamental reason: “The interpretation of a diagnostic test, the reading of an X-ray or an electrocardiogram, etc., in the absence of an E / M service or other face-to-face service with the patient, does not affect the appointment of a new patient.,” states the 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. It says, “You just need to make sure you understand the definition of a new patient.” A new patient is someone who has not received a professional service from that doctor (or another doctor of the same specialty in the same group) for the past three years.

Medicare’s decision to stop covering query codes makes mastering the new versus the established even more vital. Your choice of query code did not differ based on whether a patient was new or established, but the codes you use to replace the query did. For example, refer to codes 99241-99245 and specify: “Office visit 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.

Pay off: If the documentation supports your coding, a previously informed visit such as an inquiry as a level five E / M service, for example, knowing the difference between new and established has a hit on your pocket. The national Medicare off-site rate for a level five new patient visit (99205) pays $ 58 more than a level five visit