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Hi Dr Z. I have a question on basic EKG's. As a general practice all doctors order the standard pre /post EKG along with one view chest x-ray for standard cardiac procedures (LHC/ cardiac intervention/ EP / device implants PPM ICD etc) The billing office has always just added 59-74 or 76 to all 93005. In the pt's record I can't find documentation that the interpretation of pre /post or sequel ekg is referred to in any dicision making plans for the patient (I always think of doctors document from CCL - ex. from the angio findings, further intervention needs to be done etc.) I have also found that many times the EKG tracing are not signed and have no written interpretation from the doctor only the printed interpretation from the EKG machine, never any formal written report. Please let me know if you think the practice of adding 59/74/76 to all ECK codes 93005 is appropriate. Thanks According to the LCD from Trail Blazer L26535 - for a service to be paid the follow information need to be present in chart. Documentations Requirements Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request. Documentation should demonstrate that services are provided according to all requirements of this LCD. In this respect, the record should demonstrate the following: Evidence of recent, past, ongoing or suspected cardiac disease or symptoms. For patients in whom the ECG is performed as part of the evaluation of chest pain or symptoms that are atypical for cardiac ischemia, the record must substantiate that the ordering clinician has a valid concern that the etiology of the chest pain or other symptoms is cardiac in origin. Conversely, the record may show that the ECG is being used to exclude cardiac origin for symptoms (including chest pain) for which cardiac origin cannot be excluded by history or physical examination. For serial ECGs, information supporting the medical necessity for repeating the studies at the given interval should be present. Sequential ECGs, either short-term for an acute condition or long-term for a chronic condition, are often appropriate. Documentation must demonstrate that the findings of the test affect management of the condition. The report of the professional component (the interpretation) for the ECG must be a complete written report that includes relevant findings and appropriate comparisons. The interpretation may appear on the actual tracing or with a progress note or other report of an E/M service when the ECG is performed in conjunction with performance of an E/M service. An interpretation reported in the latter fashion, when billed as a separate service from the E/M service, should contain the same information as a report made upon the tracing itself. A simple notation of “ECG/EKG normal,” without accompanying tracing, will not not, in this circumstance, suffice as documentation of a separately payable interpretation. Preoperative ECG studies must indicate the underlying cardiac condition or risks, as well as the proposed operation for which cardiac evaluation is being performed. The ECG must be performed reasonably proximate to the proposed surgery to be considered medically necessary. Appendices N/A Utilization Guidelines Serial ECGs performed over both the short term (as for an acute condition) or over the long term (as for chronic conditions) may be appropriate when performed at a reasonable frequency. However, such ECGs will not be covered by Medicare unless it is clear that the tests are necessary for monitoring an evolving pathologic process for which the therapy will be altered based on the findings of the ECG. The interval between ECGs should be determined by the physician responsible for the patient’s care upon consideration of factors such as natural history and severity of the underlying condition, recent changes in the condition or onset of new symptoms relating to the condition, and/or the specific patient’s historical responses to therapy for his condition.