An electrocardiogram (ECG or EKG) is conducted in order to provide two major types of information. It enables a doctor to determine how long the electrical wave takes to pass through the heart by measuring time intervals. By finding out how long it takes for a wave to travel from one part of the heart to the next, the ECG can indicate whether the electrical activity of the heart is irregular, fast, slow, or normal.
The cardiologist may be able to find out if parts of the heart muscle are too large or overworked by measuring the amount of electrical activity passing through it, secondly.
Typical Costs of EKGs
Patients with medical insurance can anticipate paying a copayment ranging from $30 to $100 for both the test and the analysis, which covers a fraction of the EKG’s total cost. Generally, there are two separate expenses involved: the actual procedure cost and the analysis cost for interpreting the results.
Uninsured individuals can anticipate paying $500-$3,000 for an EKG. As per NewChoiceHealth.Com, the average cost of an EKG is $1,500, although certain establishments may charge up to $2,850. Prices for these services are generally higher in urban areas compared to smaller rural communities.
EKG Billing Services
Cardiologists frequently assess electrocardiograms (EKGs) on behalf of hospitals or other medical practices.
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But obtaining reimbursements can be tedious because of the large number of EKG billing claims and the relatively small payments per claim.
Here are a couple of additional difficulties and factors to consider with EKG billing and reimbursement.
Interfaces and Software
Generally, when dealing with hospital interfaces, two specific methods are utilized.
Reconciliation
We have observed this getting as high as 30%. If we miss 10% of their EKGs, a practice can operate without conducting a thorough reconciliation review. Reconciling means ensuring that all the EKGs you receive from the hospital align with all the EKGs you interpret. It is essential to address any overlooked parts of the process. It is not unusual for Coast First Billing Group.
How To Optimize Your EKG Reimbursement
The financial reimbursement for EKG interpretations submitted by Emergency Medicine practices has been noted to be around 80%. It should be noted that not all Cardiac Monitors and EKG reimbursements are the same for every practice, as they are subject to contractual agreements, regulations, and statutes specific to each site.
In the year 2000, there is a potential to generate $144.26 per day and $60.45 per day in a typical main shift at the Cardiac Monitor ER setting. This has been documented to occur three to four times in a year, reimbursed by some insurance carriers at a rate of 0.20.42 RVUs for the CPT code 93042 (Interpretation of Cardiac Monitor). Similarly, the potential reimbursement for the group’s interpretation of Cardiac Monitor this year is $372.51. Over the course of the year, this shift can generate up to $72.41 per day and $60.44 per day. If this site has six comparable shifts per day, the potential reimbursement could be $0.69 per day. Now, for the interpretation of EKG, the CPT code 93010 (interpretation of EKG lead 12) generates $12.69 per interpretation and 20.24 RVUs. Within the framework of the 2018 Medicare Physician Fee Schedule, this generates $432.16 per interpretation. For the interpretation of EKG lead 12, the CPT code 93010 generates $10.24 RVUs and $0.10 per interpretation.
Not All Sites will Reimburse for EKGs
The clinician who receives reimbursement in this scenario is determined by the contractual agreements, hospital policies, and/or payers’ regulations of your group of physicians. When this situation arises, both the cardiologist and the Emergency Medicine physician can analyze the same EKG of a facility. It is possible for multiple providers to interpret the same EKG. However, Medicare and certain other payers will only reimburse one EKG interpretation for a single diagnostic service. According to CPT guidelines, any eligible physician can assign a code for the service they have rendered.
The payer and specific plan differ in terms of coverage guidelines. Medically necessary procedures such as EKG monitoring may be covered by private payers. We use coding for EKG diagnosis, which is provided by payers.
Electrocardiogram (ECG or EKG) – CPT and ICD-10 Codes
Code and description of the procedure.
ICD-10-CM Diagnosis Codes for I10 Essential (primary) hypertension.
EKG Coding Tips: Modifier – 26 Don’ts
Extract from: Coding suggestions: Modifiers -25, -26, and -59, Medical Economics Journal.
When it comes to billing for EKG, here are some things to avoid:
The use of the code modifier -26 should be avoided when reporting CPT code 93000. Instead, CPT code 93010 should be used if the physician only provides the interpretation and report without the tracing. CPT code 93000 represents a standard electrocardiogram (ECG) with at least 12 leads, including the tracing, interpretation, and report. It is important not to use a more specific code when available.
Physicians can count their own interpretation towards medical decision-making, but they should not bill separately for the professional component of the test when another physician has already interpreted it.
How Your Documentation. Should Look
The EKG interpretation reveals that there are no noteworthy differences when compared to the patient’s EKG from June 2015, as interpreted by myself. There are no noticeable abnormalities in the ST/T waves. There is no evidence of left ventricular hypertrophy (LVH). The axis is normal. The heart is beating in a normal sinus rhythm with a heart rate in the 60s.
When charting, make sure that your EKG analyses are given their own dedicated space or are at least included in a distinct paragraph. It is advisable to guarantee the presence of a distinct report for EKG interpretation, as stated in CPT guidelines. Please bear this in mind.
Strive to Be Crystal Clear
Some payers may deny reimbursement for the service you have provided — so please do not disregard this. Rather than simply reviewing a charting statement, it implies that you have performed the involved work in the analysis. This clearly conveys the notation that you have performed the work involved in the analysis. It is important to be attentive to the language used in your cardiac monitoring and interpretations, so please monitor and be attentive to your EKG.
EKG Reimbursements: Medicaid & Medicare
Medicaid programs may offer coverage for EKG monitoring procedures in cases where they are considered medically essential. Criteria for coverage and the amount of payment can vary across different Medicaid programs.
Medicare generally covers stress cardiovascular testing for patients suspected or known to have ischemic heart disease and who are symptomatic. Specific coverage for indications may vary depending on the Medicare contractor. EKG monitoring may be used to detect and monitor established cardiovascular disorder or disease.
