How to Code and Bill Diagnostic Tests

The Centers for Medicare and Medicaid Services (CMS) authorities state in the Medicare Internet Only Manual (IOM): “When the attending physician is officially reviewing and providing the official interpretation of tests (e.g., EKG or X-rays), performed, this is covered as a separate item if a formal and total report is generated and available in the record. It must meet the following criteria:

• It is a written, separate part of the record.

• t contains the same key components of a report as reported by a specialist, such as a radiologist reading an X-ray or ultrasound.”

In the urgent care center providing the (E/M) service in addition to the X-ray or diagnostic test, in order to report the interpretation of the test, a separate report must be generated. The following should be included:

• Patient demographic information

• Reason for the test (sign/symptoms, etc.)

• Test performed

• Findings

This information can be found in the Medicare IOM, publication 100-14, Chapter 13, available at http://www.cms.hhs.gov/manuals/downloads/clm104c13.pdf.

EKGs in the Urgent Care Setting

A patient visits the urgent care center in the evening with chest pain. The patient is experiencing chest pain on exertion. The urgent care physician examines the patient (E/M service), taking a comprehensive history and examination and orders an EKG to rule out any cardiac involvement. An urgent care nurse performs the EKG, and the physician writes in the chart EKG normal and dates and signs the EKG tracing. The physician reports CPT code 93000 for the total component with a diagnosis of chest pain due to suspected gastroesophageal reflux disease (GERD). The patient is instructed to contact her family physician for a follow up appointment and is sent home. The diagnosis to report would be chest pain since the GERD could not be confirmed and the EKG was documented as normal.

Does this meet the requirement for interpretation and report? The answer to this question is ”No!” CPT guidelines and CMS guidelines concur that “the professional component billing is based on a review of the findings of these procedures without a complete, separately identifiable report, similar to what would be prepared by a specialist in the field, does not meet the conditions for separate payment of service.” The reason is because the review of the tracing with documentation “normal” is included in the evaluation and management payment and would not support separate payment. In addition, there are separate codes for reporting EKGs, which are:

93000 EKG total component

93005 EKG tracing only

93010 EKG Interpretation and report

In the example above, the correct code to report based on this encounter would be the E/M service and the technical component of the EKG, 93005.

Share this article: Email, Slashdot, Digg, Del.icio.us, Yahoo!MyWeb, Windows Live Favorites, Furl
Add this article feed to: RSS, My Yahoo, Newsgator, Bloglines

Read Comments [0]