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EKGs and cardiac catheterization
Date: Dec 5, 2011
Question:
I am auditing the CCL of one of our smaller system hospitals that hasn’t been audited since before I joined the audit department a few years ago. I have discovered that they are CPT 93005 (with and without modifier 59) performed with CPT codes 93458, 93459 & 93460. The EKGs are ordered as part of the standard pre-procedure routine. From my understanding, charging for the EKG is not allowed because it’s an NCCI edit. I discussed this issue with other auditors who agreed that the hospital should not be charging, as our other hospitals that I have regularly audited do not charge for them; but I pulled the “National Correct Coding Initiative Policy Manual for Medicare Services” from the CMS website and in Chapter 11, Section I, Point #14 it states:
This makes me think that the diagnostic EKG that is performed prior to the cardiac catheterization IS billable/reportable as long as it has modifier 59. What is not billable is any EKG taken during the procedure. If this is the case, then I need to instruct all of my hospitals to start reporting/billing this charge. Do you agree? I looked in your Cardiology reference guide but it only referenced that EKGs should NOT be billed with EP studies and doesn’t address cardiac catheterizations.
Thank you,
“A cardiac catheterization procedures or a percutaneous coronary artery interventional procedure may require ECG tracings to access 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.”
This makes me think that the diagnostic EKG that is performed prior to the cardiac catheterization IS billable/reportable as long as it has modifier 59. What is not billable is any EKG taken during the procedure. If this is the case, then I need to instruct all of my hospitals to start reporting/billing this charge. Do you agree? I looked in your Cardiology reference guide but it only referenced that EKGs should NOT be billed with EP studies and doesn’t address cardiac catheterizations.
Thank you,
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