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Family Practice Coding Alert

HPSA and PSA Coders, Beware:

Medicare Requires You to Break 93000 Into These Components

Bill 93005 and 93010 instead of 93000 - or face denials If your practice is located in a low physician area, stop using the global ECG code on Medicare claims. Global ECG Code Triggers Denials Rejections for 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) are piling into many family practice offices. Medicare has been denying electrocardiograms (ECGs) billed with 93000, says Rebecca L. Coogle, CCS-P, billing and coding supervisor at Anderson Family Healthcare in Minnesota. CMS advises "that we should rebill separately as technical and professional."

The instruction confuses coders who aren't accustomed to breaking the global code (93000) into:
  the technical component (93005, ... tracing only, without interpretation and report)
  and the professional component (93010, ... interpretation and report only). When a family physician (FP) owns the ECG equipment and the same physician performs and reads the ECG, you typically bill the global code, Coogle says. Geographic Designation Alters 93000 Reporting FP coders in certain geographic areas have to abandon 93000 when billing Medicare patients. "CMS added ZIP codes to the Health Professional Shortage Area (HPSA) and Physician Scarcity Area (PSA) lists, says Connie Woods, CPC, consultant with Joy Newby and Associates in Indianapolis.

Directive: If the HPSA and/or PSA lists contain your ZIP code, you have to break 93000 into the professional and technical components on 2005 claims.

Why: Medicare won't pay a bonus for the technical ECG component. HPSA and PSA practices receive extra money for being in less populated areas. "They get a 5 or 10 percent bonus for each category - or 15 percent if they qualify for both," Woods  says. But CMS will only give extra compensation for the professional work (93010), not for owning the equipment (technical component, 93005).

You Can't Reject Added Money Some FP practices feel the bonus isn't worth the trouble of separately coding 93000's components. "But you don't have the option of not participating," Woods says. Strategy: You'll have to teach staff to enter ECG charges differently for Medicare patients. When your FP owns the ECG equipment, interprets the read out, and issues a written report on his findings, you should bill:
  Medicare patients with 93005, 93010
  privately insured patients with 93000. Assure staff that reporting 93005, 93010 is correct Medicare coding. Using component codes instead of the global ECG code seems like unbundling, Coogle says. So coders may be tempted to roll the two charges into 93000.

Bottom line: But for coders working in CMS' target bonus areas, separately claiming the technical and professional components is the new 2005 ECG billing method.

Editor's note: For more information on bonus payment processes and implementation for physicians working in HPSAs and PSAs, go online to the CMS site


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