Resource EKG, ECK & Monitoring

EKG Coding​

EKG and ECG are actually different spellings of the same diagnostic test that monitors your heart's electrical activity. EKG is the abbreviation from the German spelling of electrocardiogram (which is elektrokardiogramm in German). The EKG abbreviation came into use because of where the test was initially invented.

What can an EKG - ECG check for?​

Sometimes your provider will recommend an ECG to check for heart conditions such as coronary artery disease or arrhythmia(irregular heartbeat). It can also be used to monitor your heart after a heart attack or check for signs of heart disease.

They'll also perform the test if you're showing symptoms like:

• Dizziness
• Chest pain
• Fatigue
• Shortness of breath

The procedure is painless and there is no electrical shock involved.

EKG & ED

• ED evaluation and management (E/M) codes 99281 Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional through 99285 Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making
• EKG codes 93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report, 93005 … tracing only, without interpretation and report, and 93010 … interpretation and report only

ED physician orders an EKG in their workup of a patient, they can get credit for it under the “Amount and/or Complexity of Data to Be Reviewed and Analyzed” column in the MDM table.
If the hospital does not have an arrangement with a cardiologist to interpret the EKGs, then the ED physician can perform and bill the CPT® code for the interpretation.
CPT code 93000 denotes a routine electrocardiogram (ECG) with at least 12 leads, including the tracing, interpretation, and report.
If a physician performs only the interpretation and report (without the tracing), they should report CPT code 93010-not 93000 with modifier -26.
DON’T apply it when another physician already interpreted the test. Physicians can count their own interpretation toward their medical decision-making but not bill separately for the professional component of the test.

• 93005 – Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
• 93010 – Electrocardiogram, 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

ICD-10-CM Diagnosis Codes
I10 Essential (primary) hypertension

• R94.31 Abnormal electrocardiogram [ECG] [EKG]
• R94.4 Abnormal results of kidney function studies
• I25.2 Old myocardial infarction
• T46.5X6A Underdosing of other antihypertensive drugs, [initial encounter]
• Z91.120 Patient’s intentional underdosing of medication regimen due to financial hardship
• Z01.810 Encounter for pre-procedural cardiovascular examination

The billing and coding information in this article is dependent on the coverage indications, limitations and/or medical necessity described in the associated LCD Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) L34636

Guidelines
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

1. CPT codes for Holter monitoring services (CPT codes 93224-93227) are intended for up to 48 hours of continuous recording.

• The documentation in the progress notes must reflect medical necessity for the service.
• These services may be reported globally with CPT codes 93224. Use the date of physician review as the date of service (DOS).
• When submitting claims for the recording only (CPT code 93225) or for the analysis with report only (CPT code 93226) use the date the service was performed as the DOS.
• When submitting claims for physician review and interpretation (CPT code 93227) use the date the service was performed as the DOS.
• For less than 12 hours continuous recording, modifier -52 (reduced services) should be appended.

2. List the diagnosis code(s) indicating the reason for the test.

3. The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K.

4. The codes describing technical work may be billed by an independent diagnostic testing facility (IDTF) if they meet all requirements listed in the code descriptions and coverage requirements. They may bill the total component only if the physician interpreting the test is employed or contracted by the IDTF and is not billing for the interpretation separately. The physician's name and address must be on record with our WPS Provider Enrollment Department. A letter should be sent by the physician assigning all monies collected by the IDTF for the professional codes to the billing IDTF. If a letter is not on file, professional services billed by the IDTF will be denied.

5. Do not use the "TC" or "26" modifier with the codes 93224-93229, 93268, 93270, 93271, or 93272, listed in the CPT/HCPCS section of the LCD.

6. For the same dates of service, either the wearable patient monitor or the up to 48-hour monitor will be covered (not both).

External Mobile Cardiac Telemetry Monitors
CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring.

CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:

1. Patient hook-up and patient-specific instruction and education
2. Transmission and receipt of ECG
3. Analysis of ECG by nonphysician personnel
4. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
5. Equipment maintenance
6. All supplies necessary for completion of the monitoring.

CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.

The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:

1. The date of service must be reported as the date the patient was initially placed on the monitor.
2. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
3. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.

Types of monitoring and coverage:

1. CPT Codes 93224-93227
   Continuous up to 48-hour Monitoring (CPT codes 93224-93227), includes a coverage period of up to 48-hours for one unit of service. No other EKG monitoring codes can be billed simultaneously with these codes.
2. CPT Codes 93241-93248
   Long-term continuous recorders continuously record and store for greater than 48 hours and up to 7 days or for greater than 7 days up to 15 days. No other EKG monitoring codes can be billed simultaneously with these codes and services represented by these codes are non- covered for inpatient or outpatient observation care. (Refer to current CPT codebook)
3. CPT codes 93268-93272
   Cardiac event monitor technology varies among different devices. For patient-activated event monitors, the patient initiates recording when symptoms appear or when instructed to do so by a physician (e.g., following exercise). For self-sensing automatically triggered monitors, an EKG is automatically recorded when the device detects an arrhythmia, without patient intervention. Some devices permit a patient to transmit EKG data transtelephonically (i.e., via telephone) to a receiving center where the data is reviewed. A technician may be available at these centers to review transmitted data 24 hours per day. In some instances, when the EKG is determined to be outside certain pre-set criteria by a technician or other non-physician, a physician is available 24 hours per day to review the transmitted data and make clinical decisions regarding the patient. These services are known as “24-hour attended monitoring". In other instances, transmitted EKG data is reviewed at a later time and are, therefore, considered "non-attended." (CMS Pub 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1, 20.15 Electrocardiographic Services).

The person receiving the transmission must be a technician, nurse, or a physician trained in interpreting ECG's and abnormal rhythms.
A physician must be available 24 hours a day for immediate consultation to review the transmission in case of significant symptoms or ECG abnormalities

Nationally Non-Covered Indications

The following indications are non-covered nationally unless otherwise specified below:

1. The time-sampling mode of operation of ambulatory EKG cardiac event monitoring/recording.
2. Separate physician services other than those rendered by an IDTF unless rendered by the patient's
   attending or consulting physician.
3. Home EKG services without documentation of medical necessity.
4. Emergency EKG services by a portable x-ray supplier without a physician in attendance at the time of
   the service or immediately thereafter.
5. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI unless provision is made for such 24-hour attended coverage in the manner described in section 4 above.

(CMS Pub 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 1- Coverage Determinations, 20.15 Electrocardiographic Services)

EKG Coding Conundrums

The rules for coding EKGs may change depending on the treatment scenario. Patients who report to the emergency department (ED) for an electrocardiogram The rules for coding EKGs may change depending on the treatment scenario.

www.aapc.com

Article - Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) (A57476)

Use this page to view details for the Local Coverage Article for billing and coding: electrocardiographic (ekg or ecg) monitoring (holter or real-time monitoring).

www.cms.gov