Cardiology Question for the Week of November 14, 2016

Question:

Question:

Do you know if performing an electrocardiogram (ECG) prior to a heart catheterization, cardioversion, or TEE (transesophageal echocardiogram) is included in the charge? Or can we bill it separately?

Answer:

Answer:

If the ECG is a diagnostic ECG that is separately ordered and medically necessary, it may be assigned with modifier -59. If it is routine monitoring, then it would not be separately coded.

Here are some guidelines from the NCCI Policy Manual for Medicare Services, chapter 11:

4. A number of diagnostic and therapeutic cardiovascular procedures (e.g., CPT codes 92950–92998, 93451–93533, 93600–93624, 93640–93657) routinely utilize intravenous or intra-arterial vascular access, routinely require electrocardiographic monitoring, and frequently require agents administered by injection or infusion techniques. Since these services are integral components of the more comprehensive procedures, codes for routine vascular access, ECG monitoring, and injection/ infusion services are not separately reportable. Fluoroscopic guidance is integral to diagnostic and therapeutic intravascular procedures and is not separately reportable. HCPCS/CPT codes describing radiologic supervision and interpretation for specific interventional vascular procedures may be separately reportable.

15. Cardiac catheterization, percutaneous coronary artery interventional procedures (angioplasty, atherectomy, or stenting), and internal cardioversion include insertion of a needle and/or catheter, infusion, fluoroscopy and ECG rhythm strips (e.g., CPT codes 36000, 36120, 36140, 36160, 36200–36248, 36410, 96360–96376, 71034, 76000–76001, 93040–93042). All these services are components of a cardiac catheterization, percutaneous coronary artery interventional procedure, or internal cardioversion and are not separately reportable.

16. A cardiac catheterization procedure or a percutaneous coronary artery interventional procedure may require ECG tracings to assess chest pain during the procedure. These ECG tracings are not separately reportable. Diagnostic ECGs performed prior to or after the procedure may be separately reportable with modifier 59.