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

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

Whether you call them ECG or EKG, chances are you’ll see a lot of EKGs in your practice. That means even the smallest coding errors can add up quickly. Review the basics of 93000-93010 with this service review, code components, and the role ECGs can play in selecting the E/M code.

Rely on these codes for proper ECG reports

There are three codes for routine ECG:

• 93000 – Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
• 93005 -…trace only, no 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 describe services that involve placing six chest leads of the patient and additional cables in each extremity. The procedure “collects and tracks the path 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 pick up electric current because the electrical activity of the heart generates currents that propagate to the skin.

Avoid denials with this modifier rule 26

Just say do not modify 26 (Professional Component) with your electrocardiogram codesays Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Alabama. Also, you should not add the TC (Technical Component) modifier.

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

• 93000 – Global (Professional and Technical Components)
• 93005: monitoring (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, you should choose 93010, not 93000-26.

Useful: If you ever need a reminder about whether a code accepts modifiers 26 and TC, the Medicare Medical Fee Program (MPFS) can help. According to MPFS, 93000 has a PCTC (PC, TC) flag of “4”, which stands for “global test only” code. The PCTC flag for code 93005 is “3”, indicating a “technical component only” code. And the 93010 flag of “2” means that the code is a “professional component only”. You can look up the MPFS at http://www.cms.hhs.gov/pfslookup/.

Determine if 93010 patients are ‘new’

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

Rational: “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 another face-to-face service with the patient, does not affect the appointment of a new patient”, establishes 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. She says, “You just have to make sure you understand the definition of a new patient.” A new patient is someone who has not received professional care from that doctor (or another doctor of the same specialty in the same group) in the last three years.

Medicare’s decision to no longer cover query codes makes mastering new versus established ones 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 might. For example, consultation codes 99241-99245 specify: “Office consultation for a new or established patient…” By comparison, office/outpatient E/M codes 99201-99205 are for new patients only and 99211- 99215 are for established patients only.

Pay off: If documentation supports your coding of a previously reported visit as an inquiry as a level five E/M service, for example, knowing the difference between new and established has an impact on your pocketbook. Medicare national non-facility rate for a tier five new patient visit country (99205) $58 more than a tier five country