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"Getting paid for electrocardiogram (ECG) interpretations can be challenging. Cardiologists should make sure they are using covered diagnosis codes and make separate billing arrangements with hospitals for the interpretations they perform to maximize reimbursement for the services provided, coding experts say. Cardiologists often interpret the ECG of a patient whose diagnosis was made by another physician. The patient may have been sent to the cardiologists office by a primary-care physician (PCP), or admitted to the hospital by the PCP, an emergency room physician or a surgeon. An ECG may be performed in the office using equipment owned by the cardiologist or his or her practice (93000, electrocardiogram, routine ECG with at least 12 leads; with interpretation and report); or the cardiologist may do an interpretation (93010, interpretation and report only) at the hospital. Either way, another physician may have diagnosed the patient, and when the bill for the ECG interpretation is submitted by the cardiologist, it will be denied if the diagnosis code isnt covered by the carrier, says Terry Fletcher, BS, CPC, CCS-P, a cardiology coding consultant in Dana Point, Calif. Similarly, when a patient is referred to the cardiologist for a pre-operative clearance ECG, the subsequent claim often is denied. Pre-operative clearance is standard procedure at many hospitals, but without an approved diag-nosis, the cardiologists claim will be rejected, Fletcher says. Although interpretations are not reimbursed at a high rate93010 has 0.35 relative value units (RVU), paying out at a national average of $12.60ECGs are among the top 50 services provided by cardiologists. That means those $7-$15 fees add up, and now Medicare carriers are scrutinizing ECG interpretations closely to control costs, says Cynthia Swanson, RN, CCS-P, a coding and reimbursement specialist with Seim, Johnson, Sestak & Quist, LLP, in Omaha, Neb. Medicare doesnt always want to pay for ECGs done in conjunction with a cataract or orthopedic procedure. The doctors may believe the test is medically necessary, but Medicare wont pay for it, Swanson says. Now, Medicare does not cover tests when diagnosis criteria arent met or when the test is preventive (e.g., screening) and is deemed not medically necessary by the Health Care Financing Administrations (HCFA) definition. 7 Tips to Improve Pay Up The following helpful guidelines can help you optimize reimbursement, minimize denials and stay in compliance while coding with the information you have. 1. Check Incoming Diagnosis From Referring Doctor. The information in the order form from the primary-care physician requesting the ECG may be incomplete. For example, if the patient is about to have an operation to remove cataracts, the form may not even say cataract. Instead, all it says is patient scheduled for surgery. And the cardiologists may not……………… For more read:-
http://www.supercoder.com/articles/articles-alerts/cca/7-tips-to-boost-ecg-payments/
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Cardiology codes, Boost ECG Payments, Tips to Boost ECG Payments, cpt codes, icd-9 codes, hcpcs codes, medical coding, medical billing, medical codes,
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