Electrocardiogram interpretation is not a mere review of the ECG, but rather a report on the patient and the comparative and relevant clinical data and findings revealed by the ECG. It may include measurement of all intervals and axis, rhythm and heart rate, interpretation of the tracing by the physician, summary of condition, etc.
Interpretation of computer-generated reports
To support that the physician has interpreted the computer-generated report findings as opposed to simply reviewing them, the documentation should include:
- Whether the physician agrees or disagrees with the computer-generated report findings
- Notation of what findings the physician disagrees with, if any
- Any additional or corrected information found from interpreting the findings
ECG interpretation billing
Priority Health reimburses for ECG interpretations (CPT 93010) by professional providers when the report includes these elements:
- Member demographics
- Complete, written report that details comparative data, relevant clinical data, and findings
- Indication that the reporting provider personally performed the interpretation
- Legible signature by provider of service
- Date of interpretation
The report does not have to be a separate document, it can be included in the medical record as a separate paragraph or section.
When claims include overly general language such as “ECG – normal”, which is insufficient for interpretation and report purposes, we consider that the provider has simply reviewed the ECG results, and no reimbursement is due.
The American College of Emergency Physicians (ACEP) have outlined guidelines supporting this documentation requirement within their frequently asked questions.
The Centers for Medicare and Medicaid Services have also addressed this in their Guidance Manual. Per CMS, a professional component billing based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of services (Ch. 13, Section 100.1 – X-rays and EKGs furnished to Emergency Room Patients).
The Medicare Wisconsin Physicians Service (WPS) Insurance Corporation has also addressed the documentation requirements to report an interpretation of an EKG computer-generated report.
The Coding Institute also addresses this topic in their ED Coding Alert 2011, Volume 14, which is aligned with CMS and American College of Emergency Physicians guidelines for documentation of interpretation and reports.