Common EKG CPT Codes and How to Avoid Billing Errors

Electrocardiograms (EKGs or ECGs) are diagnostic tests that can be done in nearly every medical field – cardiology, primary care, and emergency medicine. Since EKGs are so routine, a lot of mistakes are made in regards to billing, and are a common reason to receive claim and billing denials, along with other compliance issues. To decrease the chance of billing issues, the right CPT codes, documentation details and payer-specific requirements must be understood and utilized. This blog provides detailed outlines of the EKG CPT codes and provides practical guidance to reduce the chances of mistakes made when billing these codes.

What Is an EKG and Why Accurate Billing Matters

An EKG is a test that is done to assess the electrical activity of the heart. They can help with the diagnoses of heart problems such as arrhythmias, myocardial infarctions, ischemia, and other heart problems. Although the testing is simple, the billing is a lot more complex. There are a lot of components and codes that have to be separated and adjusted. Billings for EKGs must be done accurately since EKGs are considered high-volume services. Even minor coding errors, when repeated across many claims, have the potential to result in substantial revenue losses, payment delays, and compliance problems. Proper coding almost always guarantees payment, and significantly lowers the chances for claim denials and in turn, payer audits.

What Is an EKG and Why Accurate Billing Matters

EKG CPT coding has three components: global service, technical, and professional. The professional component refers to the interpretation and report created by the physician. The global code encompasses all of the components of the service. However, if components are executed by different parties, the billing must include separate CPT codes or modifiers.
Not understanding the structure of these components, causes many practices to miscode EKG bills. This causes practices to lose money. Each practice must accurately report who performed the test, who did the interpretation, and how the service should be billed.

CPT Code 93000 – Routine EKG With Interpretation and Report

CPT code 93000 covers electrocardiograms (EKGs) performed by one physician. This code describes a routine EKG performed by one physician interpreting the results and writing a report, and should be billed as a global code only when only one provider performs the technical and professional components.
This particular code is applied in physician offices where an EKG machine is owned by the office and the provider interprets the EKG themselves. A common mistake when billing practices try to bill CPT 93000 and the interpretation was done by an outside physician or facility. In that situation the billing should be done by splitting the service into its technical and professional portions rather than billing the global service.

CPT Code 93005 – Technical Component Only

CPT code 93005 is used to describe the technical part of 12-lead EKG recording. This code describes the equipment, supplies, and the staff time needed to conduct the test excluding the interpreting physician’s report.
This code is frequently used by hospitals, diagnostic testing centers, or clinics that conduct the EKG and forward the tracing to a different provider for interpretation. A common mistake is to bill for 93005 without a professional component being billed by the interpreting provider. A different issue is billing practices that apply modifiers to 93005 when it does not need it.” 93005 already reflects the technical component and does not need modifier.

CPT Code 93010 – Professional Component Only

CPT 93010 is one example of the professional component of a standard EKG. This includes the doctor’s coverage for the test, the interpretation, the report, and the documentation review, but not the report review. This is reimbursement usually received by cardiologists or doctors who look at EKG traces done somewhere else, like a hospital or urgent care.
Billing 93010 is not paying 93010 for a lot of reasons. Most of the time, there is no interpretation, or, more importantly, a report, which is not a chart note that says, “EKG reviewed,” or some such thing, like, “EKG reviewed.” This is a classic example of documentation deficit, and the documentation must indicate that there are 93010 reports, and if there is insufficient documentation, 93010 will be rejected.

CPT Code 93040 – Rhythm EKG, One to Three Leads

CPT 93040 is the code for a rhythm EKG one to three leads. This type of EKG is done for assessing rhythm. The regulatory mistakes are that some medicine practices report 93040 for the 12 leads EKG code that are fit and at routine EKG at the same time and afterwards are billed it without medical necessity the the times the documentation..

CPT Code 93041 – Rhythm EKG With Interpretation

CPT 93040 is the code for a rhythm CPT Code 93041 includes the physician’s interpretation and report and is, therefore, more costly than 93040. It is charged when a provider both performs and interprets an EKG from one to three leads.
One of the primary issues with this code is its misuse for CPT 93000. It is the practice’s burden to justify that the number of leads used is appropriate for the code selected. Reporting 93041 for a routine 12-lead EKG could cause the practice to get less pay or risk a denial.

CPT Code 93042 – Interpretation of Rhythm EKG

CPT Code 93042 is used when the interpretation and report of a rhythm EKG is performed when the tracing is done by a different provider. This code is not widely used, but it is relevant when rhythm strips are used and sent for interpretation via a different provider.
Practices often make mistakes when it appears that 93042 is used, but there is an inadequate description of the rhythm strip interpretation as a separate service. Like CPT 93010, a report that is written formally is a requirement to justify the billing here.

Common EKG Billing Errors to Avoid

Mistakes happen in EKG billing when a provider incorrectly assigns a component of a service. Errors like billing for the global code when one or more components of the service were not performed can cause overpayments or recoupments. On the flip side, not billing the professional component when the service requires it means not collecting revenue.
Another issue is billing without the right supporting documentation. Because EKGs can be interpreted in a variety of ways, there must be a signed report that includes the principal findings, impressions, and any other concerns of the assigning physician. Reports produced by EKG machines are not legal interpretations of the EKG unless a physician has reviewed and provided the supporting documentation.
Another issue is that one can incorrectly assume that a service should only be billed once and allocate resources to multiple EKG procedures only to have the claims denied or request more information. It is very important for a practice to have a solid understanding of the rules surrounding the National Correct Coding Initiative (NCCI) and the bundling rules that a payer may have.

Modifier Use and EKG Billing

Modifiers are to be used sparingly when it comes to EKG billing, but there is a specific place where they have importance, and that is EKG billing. Modifier -26 is reserved for the use of code 93000 only when the payer requests it, and this is meant to capture the professional component, but most payers do not like using code 93000 for professional billing only. Modifier -TC is not applicable for EKGs because a separate CPT code does exist for the technical component, and it is not required to be used here.
Claim denials can happen because of improper modifier usage. When adding modifiers to EKG CPT codes businesses should check the EKG payer policies.

Payer-Specific Considerations and Compliance

Different payers have different EKG coverage policies. Regarding screening versus diagnostic EKGs, Medicare has specific guidelines and may need certain diagnosis codes for reimbursement. Some commercial payers may have different policies or require pre-authorization for coverage.

To provide the best services, the staff should familiarize themselves with the updates on payer policies, coding practices, and billing procedures. Staff training and access to the latest coding tools can help in reducing mistakes.