Cardiology Question for the Week of April 18, 2016

Question:

Do you have any guidance pertaining to electrocardiograms (EKGs) performed before or after cardiac catheterizations (probably protocol-driven with standing orders) and whether or not we should append a 59 modifier or one of the new “X” modifiers?

Answer

This is a question that does not have a one-size-fits-all answer. According to the CPT book, “There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report. It is not appropriate to use these codes for reviewing the telemetry monitor strips taken from a monitoring system. The need for an electrocardiogram or rhythm strip should be supported by documentation in the patient medical record.”  

Beyond this guidance, you may want to ask this question: Would this EKG be done at this time if the patient was not about to have a heart cath (or had just finished a heart cath)? For example, if the patient had already had an EKG and has been on telemetry since, is there a documented need for another EKG? Is there a separate order with medical necessity?

Answer: