Electrocardiogram ECG/EKG CPT Code 93000 vs 93005

A graphic record of electrical potentials produced by cardiac tissue is called Electrocardiography. An electrographic tracing is created when electrical impulses produced by the heart spread to the body surface where they are detected by electrodes connected to a recording device. The ECG is valuable in the evaluation and management of primary diseases of the heart, pericardium and coronary arteries.

A qualified physician or NPP who is licensed by his state to perform these services must make an interpretation. The recording and interpretation should be part of the patient’s medical record. Electrocardiography may be useful in management of diseases that are not primarily cardiac but which frequently affect the heart either directly or indirectly.

The ECG may be utilized in the evaluation of patients with chest pain or other symptoms that are atypical but may be due to cardiac ischemia when an alternate explanation for the symptoms is not apparent. Services provided that do not directly contribute to the diagnosis or treatment of an individual patient are not medically necessary and will be denied when billed and coded appropriately. 

Electrocardiogram ECG/EKG CPT Code 

Medicare generally does not cover screening for heart disease. Though performance of a baseline ECG in certain asymptomatic patients is considered by many to be appropriate and standard medical practice. Medicare has established the limited coverage for CPT/HCPCS codes, i.e. 93000, 93005 and 93010.

Codes for ECG

There are three codes for routine ECG:

93000:  Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report 
93005: Tracing only, without interpretation and report 
93010: Interpretation and report only.

These codes include services that involves placing six leads on the patient’s chest and additional leads on each extremity. Following important points are important to consider while coding for ECG:

As mentioned above, Medicare doesn’t cover screening for heart disease. But it may pay for such an ECG only as part of the one-time preventative physical examination afforded by section 611 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

• All other electrocardiography performed on asymptomatic individuals is considered screening regardless of the presence of risk factors (for cardiac disease) such as family history, hypertension, diabetes mellitus, hyperlipidemia or advanced age in circumstances where information obtained from the electrocardiogram does not directly affect management of the underlying disease.
• Generally, one interpretation should be paid per ECG tracing. ECG interpretations that are not made contemporaneous to patient care.
• In addition to this, other interpretations that do not directly contribute to the diagnosis and treatment of the individual patient are not covered and should not be billed to Medicare.
• Some non-covered over-reading services include those that are performed by a physician. It doesn’t matter whether or not that interpretation is unavailable to the treating physician timely for use in decision-making regarding patient care.
• Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
• The record should demonstrate the evidence of recent, past, ongoing or suspected cardiac disease or symptoms of patient.
• For serial ECGs, information supporting the medical necessity for repeating the studies at the given interval should be present. 
• Surgery-specific risks related to the type of surgery and its associated degree of hemodynamic stress.
• High-risk procedures include major emergency surgery, aortic and major vascular surgeries, peripheral vascular surgery and prolonged procedures associated with large fluid shifts or blood loss.
• Intermediate-risk procedures include carotid endarterectomy, prostate surgery, orthopedic procedures, head and neck procedures, intraperitoneal and intrathoracic surgery.
• Low-risk procedures include endoscopy, superficial procedures, cataract surgery and breast surgery.

 ECG is appropriate in case of following indications like:

• Anatomic or structural abnormalities of the heart such as congenital, valvular or hypertrophic heart disease.
• Cardiac ischemia or infarction
• Systemic diseases that involve the heart.
• Rhythm disturbances and conduction system disease.
• Chest and central nervous system trauma.
• Use of medications or exposure to toxic substances that affect the heart.
• Metabolic abnormalities such as hyper/hypokalemia, hyper/hypocalcemia, hyper/hypothyroidism, acidosis, alkalosis.
• Evaluation and management related to invasive cardiac procedures.
• Evaluation of implanted electronic cardiac pacemakers.
• Preoperative management of selected patients.
• Patients with cardiac ischemia often present with chest pain.