Cardiology includes a wide range of diagnostic tests, procedures, surgeries, and interventions, each with its own specific set of codes. Medical billing and coding outsourcing is a practical strategy for healthcare providers to ensure accurate CPT and ICD-10 coding, which is essential for accurate patient records, insurance claims, and clinical decision-making.

An electrocardiogram (EKG or ECG) is a diagnostic test used to assess the heart’s electrical activity. It is a quick, painless, and noninvasive method to check for signs of heart disease. Accurate EKG coding involves translating the electrical signals generated by the heart into a standardized code that represents the heart’s activity.

Ensuring Accurate EKG Coding in the ED

According to a recent AAPC article, patients presenting to the emergency department (ED) seeking an electrocardiogram (EKG or ECG) can pose a coding challenge. The question is whether it is appropriate to report EKG CPT codes or use an alternative approach. The EKG coding approach would depend on the specific circumstances of the encounter. In other words, different coding methods should be used depending on the particular case.

If a patient receives an EKG in the ED, two code categories should be used to report the service: Emergency Department (ED) Evaluation and Management (E/M) codes and EKG codes.

• Emergency Department (ED) Evaluation and Management (E/M) codes: There are 5 levels of emergency department services represented by CPT codes 99281 – 99285:

99281 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making.

99282 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity.

99283 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity.

99284 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity.

99285 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient’s clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity.

POS 23: Emergency Room – Hospital- A portion of a hospital where emergency diagnosis and treatment of illness or injury is provided

The ED codes require the level of Medical Decision Making (MDM) to be met and documented for the level of service selected. The level of service billed must be based on the intervention(s) that are performed in relationship to the medical care required by the presenting symptoms and resulting in diagnosis of the patient. These codes are typically reported per day and do not differentiate between new or established patients. Professional codes are based on complexity, performed work, which includes the “cognitive” effort. Facility codes reflect the volume and intensity of resources used by the facility to provide care.

• EKG Codes The specific CPT code should be selected depending on the type and complexity of the ECG performed. The EKG codes are:

93000 Electrocardiogram, routine ecg with at least 12 leads; with interpretation and report

93005 Electrocardiogram, routine ecg with at least 12 leads; tracing only, without interpretation and report

93010Electrocardiogram, routine ecg with at least 12 leads; interpretation and report only

93040 Rhythm ECG, 1-3 leads; with interpretation and report

93041 Rhythm ECG, 1-3 leads; tracing only without interpretation and report

93042 Rhythm ECG, 1-3 leads; interpretation and report only

93319 3D Echocardiographic imaging and postprocessing during transesophageal echocardiography, or during transthoracic echocardiography for congenital cardiac anomalies, for the assessment of cardiac structure(s) (eg, cardiac chambers and valves, left atrial appendage, interatrial septum, interventricular septum) and function, when performed (list separately in addition to code for echocardiographic imaging)

93593 Right heart catheterization for congenital heart defect(s) Including Imaging Guidance by the proceduralist to advance the catheter to the target zone; normal native connections

93594Right heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone; abnormal native connections

93595 Left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone, normal or abnormal native connections

93596 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); normal native connections

93597 Right and left heart catheterization for congenital heart defect(s) including imaging guidance by the proceduralist to advance the catheter to the target zone(s); abnormal native connections

93598 Cardiac output measurement(s), thermodilution or other indicator dilution method, performed during cardiac catheterization for the evaluation of Congenital Heart Defects (list separately in addition to code for primary procedure)

ICD-10 Codes that Support Medical Necessity

The specific ICD-10 code should be reported on the patient’s symptoms, medical history, and the physician’s diagnosis. The ICD-10 code should accurately represent the patient’s condition for which the EKG was ordered.
Here are some common ICD-10 codes related to cardiac conditions or symptoms:

• I20.9 – Unstable angina
• R07.9 – Chest pain, unspecified
• I44.9 – Atrioventricular block, unspecified
• I47.1 – Supraventricular tachycardia
• I49.9 – Cardiac arrhythmia, unspecified
• I21.9 – Acute myocardial infarction, unspecified
• I22.9 – Subsequent myocardial infarction of unspecified site
• I10 – Essential (primary) hypertension
• I16.9 – Hypertensive heart disease without heart failure
• I50.9 – Heart failure, unspecified
• R55 – Syncope and collapse

Reporting Interpretation of the EKG in the Hospital Setting – Key Points

EKG interpretation is typically done by cardiologists, though it can be performed by ED physicians also. Here is a summary of the key points of billing EKG interpretation in these situations, as explained in the AAPC article:

• Insurance will only cover one interpretation for an EKG.
• When the hospital’s cardiologist performs and bills for the EKG interpretation, the ED physician will usually include the work of the interpretation they perform in the medical decision making (MDM) since they can’t bill for it separately.
• ED physicians do not get any MDM credit for analyzing a test they ordered. If an ED physician orders an EKG in their evaluation of a patient, they can include it under the “Amount and/or Complexity of Data to Be Reviewed and Analyzed” column in the MDM table.
• The ED physician could get MDM credit for an EKG when a different provider ordered the EKG and the ED physician analyzes it as part of their workup. In this case also, the ED physician can take credit under amount and complexity of data. However, they need to show how they used it.
• If the ED physician performs an independent interpretation of test, the claim must be accompanied by a detailed report to get credit in the MDM table. Payer rules specify the level of detail required in this report.
• Many insurance companies do not allow billing an EKG along with an ED E/M code. So getting reimbursed may be a problem when billing EKG interpretation performed by the ED physician.
• As different payers have different rules on reporting an ED E/M service and EKG on the same claim, knowing payer’s policies is essential for accurate coding.

Proper documentation is critical to justifying medical necessity and selection of codes for billing. It tells the story of a patient visit by recording pertinent facts, findings and observations. Payers will use this documentation to verify coding choices, site of service, medical necessity, appropriateness and accurate reporting of furnished services.

Outsourcing cardiology medical billing can ensure accurate code assignment and claim submission. Medical billing outsourcing companies have expertise in cardiology billing codes, payer rules and compliance. Partnering with an expert will allow healthcare providers to focus on delivering quality care to their patients, while ensuring accurate billing for timely and optimal reimbursement.