Billing and Coding: Electrocardiography

Social Security Act (Title XVIII) Standard References:

• Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L33669 Electrocardiography. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Outpatient hospitals, critical access hospitals and CORFS may use only code 93005 when billing for this service.

When billing subsequent electrocardiograms on the same day, use modifier 76 if repeated by the same provider or modifier 77 when repeated by a different provider.

When using diagnosis code Z01.810, the medical record must contain information supporting either of the two pre-operative evaluation indications listed under the “Indications and Limitations of Coverage and/or Medical Necessity” section in the related LCD.

If an EKG is being performed to evaluate a patient’s response to the administration of an agent known to result in cardiac or EKG abnormalities for patients with suspected, or at increased risk of developing cardiovascular disease or dysfunction, then diagnosis code Z79.3, Z79.891 , Z79.899 or Z51.81 should be used. The “T” diagnoses should be used when the patient is experiencing adverse effects to high risk medications.

Documentation Requirements

1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.
4. The EKG strip and a copy of the test results should be maintained in the medical record. In addition, the medical record must support that the physician interpreted and agrees with the test results and show that the results are being used to manage the patient.
5. If the provider of the service is other than the ordering/referring physician, that provider must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies. The physician must state the clinical indication/medical necessity for the study in the order for the test.