Grasping 93010’s effect on new vs. established patient status could bring a $58 reward.
Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors can add up quickly. Brush up on the 93000-93010 basics with this review of the service, the code components, and the role ECGs can play in choosing the proper E/M code.
1. Count on These Codes for Proper ECG Reporting
There are three codes for routine ECG:
- 93000 — Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
- 93005 – … tracing only, without interpretation and report
- 93010 — … interpretation and report only.
The service these codes describe typically involves placing six leads on the patient’s chest and additional leads on each extremity, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. The procedure “picks up and traces the path of electrical activity sent from the SA [sinoatrial] node through the heart and puts it onto paper,” Neighbors says.
The external skin electrodes can pick up electrical current because the heart’s electrical activity generates currents that spread to the skin, explains CPT Assistant (April 2004).
2. Prevent Denials With This Modifier 26 Rule
Just say no to modifier 26 (Professional component) with your ECG code, warns Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Ala. Similarly, you should not append modifier TC (Technical component).
Reason: Codes 93000-93010 are already broken down into professional and technical components, Huey says:
- 93000: global (professional and technical components)
- 93005: tracing (technical component)
- 93010: interpretation and report (professional component).
In other words, if the cardiologist provides only the interpretation and report for an ECG performed at a hospital, you should report 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 (professional component, technical component) indicator of “4,” meaning “global test only” code. Code 93005’s PCTC indicator is “3,” which indicates “technical component only” code. And 93010’s indicator of “2” means the code is a “professional component only.” You can search the MPFS at www.cms.hhs.gov/pfslookup/.
3. Pinpoint Whether 93010 Patients Are ‘New’
Your cardiologist’s role in an ECG interpretation could dictate whether you choose 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 face-to-face service with the patient does not affect the designation of a new patient,” states Medicare Claims Processing Manual, Chapter 12, Section 30.6.7 (www.cms.hhs.gov/Manuals/).
You just need to be sure you understand the definition of a new patient, says Betsy Nicoletti, MS, CPC, founder of Medical Practice Consulting in Springfield, Vt. A new patient is one who has not received professional service from that physician (or another physician of the same specialty in the same group) during the past three years.
Medicare’s decision to no longer cover consult codes makes mastering new versus established even more important. Your consult code choice did not 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 contrast, office/outpatient E/M codes 99201-99205 are for new patients only and 99211-99215 are for established patients only.
Payoff: If documentation supports coding a visit previously 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 wallet. The Medicare nonfacility national rate for a level-five new patient visit (99205) pays $58 more than a level-five established patient visit (99215).
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