Definition
An electrocardiogram (ECG) is a graphic representation of electrical activity within the heart. Electrodes placed on the body in predetermined locations sense this electrical activity, which is then recorded by various means for review and interpretation.
ECG interpretation isn’t a mere review of the ECG, but rather a report on the patient and the comparative and relevant clinical data and findings revealed by the ECG. It may include measurement of all intervals and axis, rhythm and heart rate, interpretation of the tracing by the physician, summary of condition, etc.
Interpretation of computer-generated reports
To support that the physician has interpreted the computer-generated report findings as opposed to simply reviewing them, the documentation should include:
- Whether the physician agrees or disagrees with the computer-generated report findings
- Notation of what findings the physician disagrees with, if any
- Any additional or corrected information found from interpreting the findings
ECG interpretation billing
Payable:
Priority Health reimburses for ECG interpretations (CPT 93000, 93010 or G0403) by professional providers when the report includes these elements:
- Member demographics
- Complete, written report that similar to one that is prepared by a specialist in the field. The content of the written report must address the relevant clinical issues, available comparative data and test findings. The format of the report must be separately identifiable. It may be included under a separate heading within the clinical record or written on the ECG tracing itself, with a reference in the clinical record.
- Indication that the reporting provider personally performed the interpretation
- Legible signature by provider of service
- Date of interpretation
- Legible patient medical record that clearly indicates the reasonableness and necessity of the service
The report does not have to be a separate document, it can be included in the medical record as a separate paragraph or section.
Not payable:
When claims include overly general language such as “ECG – normal”, which is insufficient for interpretation and report purposes, we consider that the provider has simply reviewed the ECG results, and no reimbursement is due.
An ECG isn’t payable when used for screening purposes or as part of a routine physical examination. Routine physical examinations (screening) are evaluation and management services supplied in the absence of associated signs, symptoms or complaints.
References
- The American College of Emergency Physicians (ACEP) have outlined guidelines supporting this documentation requirement within their frequently asked questions.
- The Centers for Medicare and Medicaid Services have also addressed this in their Guidance Manual. Per CMS, a professional component billing based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of services (Ch. 13, Section 100.1 – X-rays and EKGs furnished to Emergency Room Patients).
- The Medicare Wisconsin Physicians Service (WPS) Insurance Corporation has also addressed the documentation requirements to report an interpretation of an EKG computer-generated report.
- The Coding Institute also addresses this topic in their ED Coding Alert 2011, Volume 14, which is aligned with CMS and American College of Emergency Physicians guidelines for documentation of interpretation and reports.
- Billing and Coding: Electrocardiograms – A57326 (CMS)