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93040 with an hospital E&M.

Kathy Posted Tue 27th of January, 2015 10:41:15 AM

I have found many different resources on this. Some say it is billable while others say it is not. I have also seen that it is billable only as an out patient. Can you clarify this for me?

SuperCoder Answered Tue 27th of January, 2015 12:18:01 PM

Thanks for your question. Code 93040 represents the technical and professional components of the service, so you should not append modifier 26, Professional component, or TC, Technical component. To report the technical component only, the rendering provider should report 93041, Rhythm ECG, one to three leads, tracing only without interpretation and report. To report the professional component only, the rendering provider should report 93042, Rhythm ECG, one to three leads, interpretation and report only.

CPT® is quite clear in the E/M services guidelines that the actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services. So, if your physician has indeed performed ECG interpretation and report, he can certainly bill it separately apart from E/M, along with modifier 25.

Some payers refuse to reimburse for diagnostic interpretations in the ED setting, claiming they are bundled into the E/M service and counted in the amount and complexity of data reviewed component of medical decision making.

CPT® instructs that there must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report. The need for an electrocardiogram or rhythm strip should be supported by documentation in the medical record.

As supporting documentation, please check the below link of CMS Transmittal (P-15):
http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf

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