Family physicians (FPs) don't always carry out the same electrocardiogram (ECG) service - the differences in where and what they provide decide your CPT 93000, 93005 or 93010 selection.
In case an in-office machine spits out the information, and then the FP issues a report, you must report the complete code CPT 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), which certainly pays more than $26. However, determining which code to report when your practice doesn't deliver the tracing or interpret the results is more challenging.
You shouldn't fall into the trap of using modifiers -TC (Technical component) and -26 (Professional component) on CPT 93000. You should as an alternative report 93005 (€¦ tracing only, without interpretation and report) for the technical component and 93010 (€¦ interpretation and report only) for the professional service.
Why does CPT use 93000-93010 rather than modifiers -TC and -26 for ECG component coding? When CPT developed the ECG codes, many payers didn't recognize modifiers. To avoid insurers ignoring the modifiers and in turn rejecting claims for what would then appear as duplicate CPT 93000 billing, CPT assigned precise codes for the services. To decide when to use 93000-93010, medical coding experts mention four guidelines:
1. Bill 93005 for In-Office Procedure
In case your FP carries out an in-office ECG without interpreting the report, you must assign 93005 for the technical component. Code 93005 contains of the FP or his staff placing the 12 leads on the patient, carrying out the standardization process and taking the gel off the patient at the end of the ECG.
2. Use 93010 for Report Only
Occasionally the FP carries out the ECG in the hospital however still issues the report. In this case, you must bill 93010 for the professional component.
To get the $9 for carrying out the professional component, your FP needs to document that he interpreted the ECG's printout. As the technical component (93005) contains the machine's report, the FP should show that he did more than look at the printout.
Medicare and other carriers anticipate the FP to write report interpretations on the machine's 8 x 11 sheet or strip report. Appropriate documentation comprises stating why the doctor agrees or disagrees with the machine's description and signing and dating the report.
3. Assign 93000 for Procedure and Report
You must bill the global code CPT 93000 when your FP carries out the ECG and documents his findings. You will have no problems with Medicare and other insurers reimbursing you for ECGs, provided you follow these rules.
4. Employ Other-Physician Interpretations Options
A number of FPs do not feel contented reading the ECG reports and hire a cardiologist or internist to interpret the printout. In this case, each doctor must bill for his own role.