93000 – 93010 – Brush up on your ECG coding skills with these 3 key pointers
Understanding the effects of 93010 on new vs. established patient status can bring a $58 reward.
Whether you call them EKGs or EKGs, chances are you see a lot of electrocardiograms in your practice. This means that even the smallest coding errors can add up quickly. Brush up on the basics of 93000-93010 with this overview of service, code components, and the role ECGs can play in choosing the right E/M code.
Rely on these codes for correct ECG readings
There are three codes for a routine ECG:
- 93000 – Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
- 93005 -… only trace, no interpretation and report
- 93010 -… only translation and report
Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at the Heart and Vascular Center St. Joseph in Tacoma, Wash., says those codes describe services that include placing six wires on the patient’s chest and additional wires on each limb. The procedure “receives and traces the path of electrical activity sent by the SA [sinoatrial] knot through the heart and puts it on paper,” adds Neighbors.
CPT Assistant (April 2004) explains that external skin electrodes can pick up electrical current because the electrical activity of the heart generates currents that propagate to the skin.
Prevent bounces with this 26 modifier rule
Just say no to modifier 26 (pro component) with yours ECG codesays Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Ala. Likewise, you should not add a TC (Technical Component) modifier.
Reason: Codes 93000-93010 are now divided into professional and technical components, Huey says:
- 93000: Global (professional and technical components)
- 93005: tracking (technical component)
- 93010: interpretation and report (professional component).
In other words, if the cardiologist only provides the interpretation and report of an EKG performed in a hospital, you should select 93010, not 93000-26.
useful: If you ever need a reminder about whether a code accepts modifiers 26 and TC, the Medicare Physician Fee Schedule (MPFS) can be helpful. According to MPFS, 93000 has a PCTC (PC, TC) indicator of “4”, meaning a “global test only” code. The PCTC indicator of code 93005 is “3”, indicating a “technical component only” code. And the indicator “2” on 93010 means that the code is “professional component only”. You can search the MPFS at http://www.cms.hhs.gov/pfslookup/.
Determine if 93010 patients are “new”
Your cardiologist’s role in ECG interpretation may dictate whether you select a new or established patient E/M code at the patient’s next visit.
Justification: “Interpretation of a diagnostic test, reading of an X-ray or EKG, etc., in the absence of an E/M service or other face-to-face service, does not affect the determination of a new patient,” says the Processing Manual Medicare Claims, 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 professional care from that doctor (or another doctor in the same specialty in the same group) in the past three years.
Medicare’s decision to no longer cover consultation codes makes mastering new versus established even more important. Your choice of consultation code does not differ depending on whether the patient is new or established, but the codes you use to replace the consultation may be. For example, consultation codes 99241-99245 specify: “Office consultation for 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 .
I am repaying: If documentation supports your coding, a visit that was previously billed as a consultation as a level five E/M service, for example, knowing the difference between new and established has an impact on your pocket. The national Medicare non-facility rate for a new patient visit at level five (99205) pays $58 more than level five
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