EKG – ECG CPT codes and related ICDs

CPT CODES:

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

Fee schedule Of EKG Codes

Its varies insurance to insurance however the below table would give you the basic idea of reimbursement.

Billing and Coding Guidelines

BCBSNC will reimburse for interpretation of the ECG once, except under unusual consultative circumstances. The interpretation or the fee for the interpretation should be submitted based on place of service where the ECG was performed.

BCBSNC reimbursement for the professional component (CPT 93010) is for “interpretation and report” of an ECG procedure, not “review” of the procedure. A review of the findings of these procedures, without a written report, does not meet the conditions for separate payment of the service since the review is already included in the emergency room visit payment.

“Global only” codes represent a routine ECG with at least 12 leads and include the physician’s interpretation and report. Other CPT codes are established to specify the “technical” component, (the ECG tracing only), and the “professional” component (for interpretation and report only). It is not appropriate to use modifiers -26 or –TC with these latter codes. ..

Anthem Central Region bundles 93000, 93010, 93018, 93040, 93042 and 0180T as redundant/mutually exclusive to 99281-99285. Anthem considers interpretations of tests to be a component of performing the evaluation and management service. An ECG is performed while the patient is in the emergency department. The emergency physician performing his evaluation and management service interprets this ECG and makes a decision as to the type of treatment that is required for this patient. This interpretation is a component or part of the decision making portion of the evaluation and management services

BCBS Guidelines
In the Pathologist section added code 85060 to the list of codes eligible for clinical interpretation. Changed the wording from “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral service.” to “Pathology interpretation of all other codes in the 80002-87999 range is considered an integral to the laboratory test.” Changed the words “mutually exclusive” to “incidental” in the Cardiac Stress Test section.

Removed code 93000 and 93040 because the incidental logic no longer applies to 99291 and 99292 in the Critical Care section. Code 93798 removed from the Electrocardiograms section. Removed code 82800, 82805, 82810, 93000, 93040 and 94640 because the incidental logic no longer applies to codes 99296, 99294, 99295, 99296 and 99298 in the Neonatal Intensive Care Services. Changed the word from “incidental” to “mutually exclusive” in the Transvaginal Ultrasound section. Removed the Maldistribution of Inspired Gas, Chlamydia Testing by Direct or Amplified Probe Technique, Fluoroscopic Guidance and Voiding Pressure Studies section. Removed any deleted codes. Policy reviewed 10/26/07 by Senior Medical Director of Provider Partnerships, Medical and Reimbursement Policy.





Electrical Stimulation Electrodes

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement for incidental supplies is not allowed.

Electrocardiograms Electrocardiograms (ECG) (e.g., CPT codes 93000, 93005, 93010) will not be separately reimbursed when submitted with a cardiac stress test (CPT code 93015), a cardiac test that includes an ECG as part of the test, or with initial hospital care. A three-lead ECG is considered incidental to a 12-lead ECG. Separate reimbursement for ECGs that are considered incidental is not allowed. An ECG is considered mutually exclusive to physician services for cardiac rehabilitation (CPT code 93797). Separate reimbursement for ECGs that are considered mutually exclusive is not allowed.

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit. Fetal Non-Stress Test 59025

Effective October 17, 2011, we will consider more than one fetal non-stress test performed on the same date of service when the test is being performed on more than one fetus in a multiple gestation situation. The diagnosis on the claim must reflect the multiple gestation. See the list of eligible diagnoses below: 651.00 651.03 651.10 651.13 651.20 651.23 651.30 651.33 651.40 651.43 651.50 651.53 651.60 651.63 651.80 651.83 651.90 651.93

Categories of CV Codes

• Cardiography (CPT 93000 – 93042)
– Electrocardiogram (EKG)
– Cardiovascular Stress Tests (Treadmills)

• Cardiovascular Monitoring Services (93224 – 93278)

• Implantable & Wearable Cardiac Device Evaluations (CPT 93279 – 93299)
– Attended Surveillance
– Devices
• Pacemaker

– Single Lead
– Dual Lead
– Multiple Lead

• Implantable CV Monitor (ICM)
• Implantable Cardioverter-defibrillator (ICD)
• Implantable Loop Recorder (ILR)

• Echocardiography (93303 – 93464)

– Complete (initial )Studies
– Follow-Up or Limited Studies
– TEE (Transesophageal)
– Doppler – sometimes reported in addition
– Color Flow Mapping – sometimes reported in addition

• Cardiac Catheterization (CPT 93451 – 93581)

Electrical Stimulation Electrodes

The supply of electrodes is considered incidental to electrical stimulation. Separate reimbursement for incidental supplies is not allowed.

Electrocardiograms Electrocardiograms (ECG) (e.g., CPT codes 93000, 93005, 93010) will not be separately reimbursed when submitted with a cardiac stress test (CPT code 93015), a cardiac test that includes an ECG as part of the test, or with initial hospital care. A three-lead ECG is considered incidental to a 12-lead ECG. Separate reimbursement for ECGs that are considered incidental is not allowed. An ECG is considered mutually exclusive to physician services for cardiac rehabilitation (CPT code 93797). Separate reimbursement for ECGs that are considered mutually exclusive is not allowed.

Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit. Fetal Non-Stress Test 59025

Effective October 17, 2011, we will consider more than one fetal non-stress test performed on the same date of service when the test is being performed on more than one fetus in a multiple gestation situation. The diagnosis on the claim must reflect the multiple gestation. See the list of eligible diagnoses below: 651.00 651.03 651.10 651.13 651.20 651.23 651.30 651.33 651.40 651.43 651.50 651.53 651.60 651.63 651.80 651.83 651.90 651.93

20 Professional Component (PC)/Technical Component (TC) Indicator payment guidelines

0 = Physician service codes: This indicator identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 & TC cannot be used with these codes. The total Relative Value Units (RVUs) include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.

1 = Diagnostic tests or radiology services: This indicator identifies codes that describe diagnostic tests, e.g., pulmonary function tests, or therapeutic radiology procedures, e.g., radiation therapy. These codes generally have both a professional and technical component. Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense, and malpractice expense. The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only. The total RVUs for codes reported without a modifier equals the sum of RVUs for both the professional and technical component.

2 = Professional component only codes: This indicator identifies stand alone codes that describe the physician work portion of selected diagnostic tests for which there is an associated code that describes the technical component of the diagnostic test only and another associated code that describes the global test. An example of a professional component only code is 93010, Electrocardiogram; interpretation and report. Modifiers 26 and TC cannot be used with these codes. The total RVUs for professional component only codes include values for physician work, practice expense, and malpractice expense.

3 = Technical component only codes: This indicator identifies stand alone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic tests only.

An example of a technical component code is 93005,  Electrocardiogram, tracing only, without interpretation and report. It also identifies codes that are covered only as diagnostic tests and therefore do not have a related professional code. Modifiers 26 and TC cannot be used with these codes. The total RVUs for technical component only codes include values for practice expense and malpractice expense only.

4 = Global test only codes: This indicator identifies stand alone  codes for which there are associated codes that describe: a) the professional component of the test only and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.

EKG (ECG) Interpretation

For EKGs, the interpretation must include appropriate comments on any three of the following six elements: (1) the rhythm or rate (2) axis, (3) intervals, (4) segments, (5) notation of a comparison with a prior EKG if one was available to the physician, and (6) summary of clinical condition.

An EKG with interpretation must have the full graphic tracings with formal written or printed interpretation on file for review. The interpretation should appear on the designated sections of a page formatted EKG or written in the clinical records. Interpretations should include appropriate comments on rhythm, axis intervals, acute or chronic changes and a comparison with the most recent tracing. While every single parameter is not required for each tracing, the appropriate measurements must be mentioned if the purpose of repeated EKGs is to monitor the effects of a given parameter (e.g., the QT interval).

Example:

* EKG reveals normal sinus rhythm, no axis deviation, no acute changes.
* EKG reveals atrial fibrillation, rapid ventricular response, non-specific ST-T wave changes.
* EKG reveals normal sinus rhythm, normal axis, T-wave inversion in V3 and V4 and Twave flattening and high laterally. No EKG was available for comparison. Common Question Regarding Electrocardiogram (EKG) and Computer Generated Reports

Question:

The EKG equipment we use not only provides the strip showing the rhythm, but also generates a report on the findings. Can I bill for the interpretation (whether as a global service or the professional component only) for this computer-generated report?

Answer:

A provider may use the computer-generated report as the basis of his/her interpretation and report of the test. However, a provider may only submit a claim for the professional component of this service when the situation meets certain qualifications.

1) There must be a notation of the physician’s opinion of the computer decision – whether he/she agrees or disagrees.
2) If the physician disagrees with the computer decision or has additional information to supply, he/she must notate the disagreement or additional information. He/she can mark out or cross through the part he/she disagrees with, indicating the correct information. A common error seen in the computer-generated decision is that it indicates “RBBB” but the rhythm is actually a completely paced rhythm. Medicare would expect to see something similar to “Disagree with RBBB. Completely paced rhythm with ventricular rate of 72; agree with rest.”
3) The physician must sign his or her notation.

COVERED DIAGNOSIS:


002.0 Typhoid fever

005.1 Botulism

017.90-017.96 Tuberculosis of specified organs

018.00-018.96 Miliary tuberculosis

020.2 Septicemic plaque

022.3 Anthrax septicemia

032.82 Diptheritic myocarditis

036.2 Meningococcemia

036.40-036.43 Meningococcal carditis

038.0-038.9 Septicemia

040.0 Gas gangrene

042 Human immunodeficiency virus (HIV) disease

054.5 Herpetic septicemia

074.1 Epidemic pleurodynia

074.20-074.23 Coxsackie carditis

086.0 Chagas’ disease with heart involvement

088.81 Lyme disease

093.0-093.9 Cardiovascular syphilis

098.83-098.85 Gonococcal heart disease

112.5 Disseminated candidiasis

112.81 Candidial endocarditis

115.03-115.04 Infection by histoplasma capsulatum

115.13-115.14 Infection by histoplasma duboisii

115.93-115.94 Histoplasmosis, unspecified

124 Trichinosis

130.3 Myocarditis due to toxoplasmosis

130.8 Multisystemic disseminated toxoplasmosis

135 Sarcoidosis

163.0-163.9 Malignant neoplasm of pleura

164.0-164.9 Malignant neoplasm of thymus, heart, and mediastinum

165.0-165.9 Malignant neoplasm of other and ill-defined sites within the respiratory system and intrathoracic organs

212.4-212.7 Benign neoplasm of respiratory and intrathoracic organs

242.00-242.91 Thyrotoxiosis with or without goiter

243 Congential hypothyroidism

244.0-244.9 Acquired hypothroidism

245.0-245.9 Thyroiditis

252.0-252.9 Disorders of parathroid gland

255.0-255.9 Disorders of adrenal glands

265.0-265.2 Thiamine and niacin deficiency states

270.0 Disturbances of amino-acid transport

272.0-272.9 Disorders of lipoid metabolism

274.82 Gouty tophi of other sites

275.2-275.3 Disorders of mineral metabolism; magnesium/phosphorus

275.40-275.49 Disorders of calcium metabolism

276.0-276.9 Disorders of fluid, electrolyte, and acid-base balance

277.3 Amyloidosis

277.5 Mucopolysaccharidosis

282.60-282.69 Sickle-cell anemia

305.50-305.53 Opioid abuse

305.60-305.63 Cocaine abuse

305.70-305.73 Amphetamine or related acting sympathomimetic

306.2 Physiological malfunction arising from mental factors; cardiovascular

337.0 Idiopathic peripheral autonomic neuropathy

357.6 Polyneuropathy due to drugs

362.30-362.37 Retinal vascular occlusion

390 Rheumatic fever without mention of heart involvement

391.0-391.9 Rheumatic fever with heart involvement

392.0-392.9 Rheumatic chorea

393 Chronic rheumatic pericarditis

394.0-394.9 Diseases of mitral valve

395.0-395.9 Diseases of aortic valve

396.0-396.9 Diseases of mitral and aortic valves

397.0-397.9 Diseases of other endocardial structures

398.0-398.99 Other rheumatic heart disease

401.0-401.9 Essential hypertension

402.00-402.91 Hypertensive heart disease

403.00-403.91 Hypertensive renal disease

404.00-404.93 Hypertensive heart and renal disease

405.01-405.99 Secondary hypertension

410.00-410.92 Acute myocardial infarction

411.0-411.89 Other acute and subacute forms of ischemic heart disease

412 Old myocardial infarction

413.0-413.9 Angina pectoris

414.00-414.9 Other forms of chronic ischemic heart disease

415.0-415.19 Acute pulmonary heart disease

416.0-416.9 Chronic pulmonary circulation

420.0-420.99 Acute pericarditis

421.0-421.9 Acute and subacute endocarditis

422.0-422.99 Acute myocarditis

423.0-423.9 Other diseases of pericardium

424.0-424.99 Other diseases of endocardium

425.0-425.9 Cardiomyopathy

426.0-426.9 Conduction disorders

427.0-427.9 Cardiac dysrhythmias

428.0-428.9 Heart failure

429.0-429.9 Ill-defined descriptions and complications of heart disease

430 Subarachnoid hemorrhage

431 Intra-cerebral hemorrhage

432.0-432.9 Other and unspecified intra-cranial hemorrhage

433.00-433.91 Occlusion and stenosis of precerebral arteries, with or without cerebral infarction

434.00-434.01 Occlusion of cerebral arteries: cerebral thrombosis

434.10-434.11 Occlusion of cerebral arteries: cerebral embolism

434.90-434.91 Occlusion of cerebral arteries: cerebral artery occlusion unspecified

435.0-435.9 Transient cerebral ischemia

435 Acute, but ill-defined cerebrovascular disease

437.0-437.9 Other and ill-defined cerebrovascular disease

440.9 Generalized and unspecified atherosclerosis

441.00-441.9 Aortic aneurysm and dissection

442.89 Of other specified artery: other

443.0-443.9 Other peripheral vascular disease

444.0-444.9 Arterial embolism and thrombosis

446.0-446.7 Polyarteritis nodosa and allied conditions

458.0-458.9 Hypotension

491.20-491.21 Obstructive chronic bronchitis: with or without mention of acute exacerbation

492.0-492.8 Emphysema

493.00-493.92 Asthma

496 Chronic airway obstruction; not elsewhere classified

506.1 Acute pulmonary edema due to fumes and vapors

511.0-511.9 Pleurisy

514 Pulmonary congestion and hypostasis

518.2 Compensatory emphysema

518.4 Acute edema of lung, unspecified

518.5 Pulmonary insufficiency following trauma and surgery

518.81-518.84 Acute respiratory failure

519.3 Other diseases of mediastinum, not elsewhere classified

530.0-530.5 Diseases of esophagus

530.81 Esophageal reflux

552.3 Diaphragmatic hernia with obstruction

575.0 Acute cholecystitis

575.10-575.12 Other cholecystitis

580.0-580.4 Acute glomerulonephritis

585 Chronic renal failure

511.71 Mastodynia

634.50-634.62 Spontaneous abortion

635.50-635.62 Legally induced abortion

636.50-636.62 Illegally induced abortion

637.50-637.62 Unspecified abortion

638.5-638.6 Failed attempt4ed abortion

639.5-639.8 Complications following abortion and ectopic and molar pregnancies

642.00-642.94 Hypertension complicating pregnancy, childbirth, and puerperium

648.50-648.54 Other current conditions in the mother classifiable elsewhere, but complication pregnancy, childbirth, or the puerperium: congenital cardiovascular disorders

668.00-668.04 Complications of the administration of anesthetic or other sedation in labor and delivery; pulmonary complications

668.10-668.14 Complication of the administration of anesthetic or other sedation in labor and delivery; cardiac complications

669.10-669.14 Other complications of labor and delivery, not elsewhere classified; shock during or following and delivery

669.20-669.24 Other complications of labor and delivery, not elsewhere classified; maternal hypotension syndrome

669.40-669.44 Other complications of labor and delivery, not elsewhere classified; other complication of obstetrical surgery and procedures

673.00-673.84 Obstetrical pulmonary embolism

674.80 Other and unspecified complications of the puerperium, unspecified as to episode of care or not applicable

674.84 Other and unspecified complications of the puerperium, postpartum condition of complication

710.0 Systemic lupus erythematosus

714.0-714.9 Rheumatoid arthritis and other inflammatory polyarthropathies

719.41 Pain in joint

724.1 Pain in thoracic spine

729.5 Pain in limb

729.81-729.89 Other musculoskeletal symptoms referable to limbs

733.6 Tietz’s disease

738.3 Acquired deformity of chest and rib

745.0-745.9 Bulbus cordis anomalies and anomalies of cardiac septal closure

746.00-746.9 Other congenital anomalies of heart

747.00-747.49 Other congenital anomalies of circulatory system

754.81-754.82 Other specified nonteratogenic anomalies

780.01-780.09 Alteration of consciousness

780.1 Hallucination

780.2 Syncope and collapse

780.31-780.39 Convulsions

780.4 Dizziness and giddiness

780.50-780.59 Sleep disturbances

780.71-780.79 Malaise and fatique

782.0 Disturbance of skin sensation

782.3 Edema

782.5 Cyanosis

782.61-782.62 Pallor and flushing

784.1 Throat pain

785.0-785.9 Symptoms involving cardiovascular system

786.00-786.09 Dyspnea and respiratory abnormalities

786.5-786.59 Chest pain

787.01-787.03 Nausea and vomiting

787.1 Heartburn

789.00-789.09 Abdominal pain

789.1 Hepatomegaly

790.4 Nonspecific elevation of levels of transaminase of lactic acid dehydrogenase (LDH)

793.1-793.2 Nonspecific abnormal findings on radiological and other examination by body structure

794.30-794.39 Nonspecific abnormal results of function studies; cardiovascular

799.1 Respiratory arrest

807.0-807.09 Fracture of rib(s), closed

807.10-807.19 Fracture of rib(s), open

807.2-807.4 Fracture of rib(s) and sternum

860.0-860.5 Traumatic pneumothorax and hemothorax

861.00-861.32 Injury to heart and lung

862.0 Injury to diaphragm without mention of open would into cavity

862.21-862.39 Injury to other and unspecified intrathoracic organs

862.8-862.9 Injury to multiple and unspecified intrathoracic organs

875.0-875.1 Open wound of chest (wall)

901.0-901.89 Injury to blood vessels of thorax

922.1 Contusion of chest wall

926.8-926.9 Crushing injury of multiple sites of trunk or unspecified site

958.0-958.1 Certain early complications of trauma; air or fat embolism

958.4 Traumatic shock

959.1 Injury, other and unspecified; trunk

963.1 Poisoning by antineoplastic and immunosuppressive drugs

972.0-972.9 Poisoning by agents primarily affecting the cardiovascular system

986 Toxic effect of carbon monoxide

989.3 Toxic effect of organophosphate and carbamate

989.4 Toxic effect of other pesticides, not elsewhere classified

991.6 Hypothermia

992.0 Heat stroke and sunstroke

992.1 Heat syncope

992.3 Heat exhaustion, anhydrotic

993.2 Other and unspecified effects of high altitude

993.3 Caisson disease

993.4 Effects of air pressure caused by explosion

994.0 Effects of lightning

994.1 Drowning and nonfatal submersion

994.4 Exhaustion due to exposure

994.5 Exhaustion due to excessive exertion

994.7 Asphyxiation and strangulation

994.8 Electrocution and nonfatal effects of electrical current

995.0 Other anaphylactic shock

995.4 Shock due to anesthesia

995.60-995.69 Anaphylactic shock due to adverse food reaction

995.89 Other specified adverse effects, not elsewhere classified; other

996.00-996.09 Mechanical complication of cardiac device implant, and graft

996.61 Infection and inflammatory reaction due to cardiac device, implant, and graft

996.71-996.72 Other complications of internal (biological) (synthetic) prosthetic device, implant, and graft

996.83-996.84 Complications of transplanted heart and lung

997.1 Cardiac complications

997.4 Digestive system complications

998.0 Postoperative shock

999.1 Complications of medical care, not elsewhere classified; air embolism

999.4 Complications of medical care, not elsewhere classified; anaphylactic shock due to serum

999.5 Complications of medical care, not elsewhere classified; other serum reaction

999.9 Other and unspecified complications of medical care; not elsewhere classified

V15.1 Other personal history presenting hazards to health; surgery to heart and great vessels

V42.1-V42.2 Organ or tissue replaced by transplant

V43.2-V43.4 Organ or tissue replaced by other means

V45.00-V45.09 Cardiac device in situ

V45.81-V45.82 Other post-surgical status

V47.2 Other cardiorespiratory problems; cardiovascular exercise intolerance with pain (with); at rest, less than ordinary activity, ordinary activity

V53.31-V53.39 Fitting or adjustment of other cardiac device

V58.69 Long-term (current) use of other medications

V67.51 Following completed treatment with high-risk medications, not elsewhere classified

E925.0-E925.9 Accident caused by electric current