Can We Score Interpretation of an EKG Towards E/M Medical Decision Making?

October 10th, 2023 - Aimee Wilcox

Electrocardiograms (EKGs), echocardiograms (ECGs), and chest x-rays are extremely common diagnostic tests performed in the office and facility setting, but how do you know when interpretation of these test can be scored towards the Evaluation & Management (E/M) medical decision making (MDM) element?

Question:

Can you elaborate on the interpretation of an EKG with E/M? When does it count for scoring and when does it not count?

Answer:

According to the 2023 CPT Evaluation and Management (E/M) coding guidelines,

“The amount and/or complexity of data to be reviewed and analyzed. These data include medical records, tests, and/or other information that must be obtained, ordered, reviewed, and analyzed for the encounter. This includes information obtained from multiple sources or interprofessional communications that are not reported separately and interpretation of tests that are not reported separately. “ (underscore added for emphasis)

There are three ways to separately report an EKG or ECG with at least 12 leads:

Routine EKG/ECG with 12 leads

- 93000 including interpretation and report
- 93005 Tracing only without interpretation and report
- 93010 Interpretation and report only

When a provider orders, performs, and interprets a 12-lead EKG/ECG, and bills 93000 for it, it does not qualify for scoring the MDM Data to determine the level of E/M service to be reported. Tests that are ordered must be analyzed and the provider is being paid to analyze the test results. To score this as part of the E/M MDM Data would be double dipping, which is not allowed.

If a physician and a physician assistant (PA) or nurse practitioner (NP) in the same specialty or subspecialty split the work of 93000, it is still not scored as part of the E/M MDM Data, as the practice is billing for 93000 and both providers are of the same specialty/subspecialty.

Let’s review an example of when it would be appropriate for an ordering physician to score the EKG as part of the E/M MDM Data:

Scenario: John is seen in the emergency department (ED) for chest pain and an irregular heartbeat. The ED physician, Dr. Logan orders an EKG. The ED nurse (employed by the hospital) performs the EKG, which produces a tracing that must be reviewed and interpreted by a qualified provider. The hospital will report 92005 for the tracing only. The tracing is provided to the Cardiology Service, Dr. Ishmael for interpretation and report. The Cardiology Service will report 93010, which completes the requirement for an EKG with interpretation and report. Dr. Logan reviews the report and tracing and agrees with Dr. Ishmael’s interpretation, noting Dr. Ishmael’s interpretation and decides on the patient’s treatment.

Coding and Explanation:

The hospital will bill 93005 for their nurse who performed the technical portion of the EKG.
The Cardiology Service provider, Dr. Ishmael, will bill for 93010 for the EKG professional interpretation and report.
Dr. Logan will get one point towards E/M MDM Data ordered and analyzed for ordering the EKG and reviewing the result (Dr. Ishmael’s interpretation) with the patient.

Scenario: The exact same scenario occurs but with slight changes: Dr. Logan reviews the tracing and and documents her own interpretation in the patient’s medical record. Dr. Ishmael, of the Cardiology Service, later reviews the tracing and produces a report with his interpretation of the EKG.

Coding and Explanation:

The hospital will bill 93005 for the technical performance of the EKG by their nurse.
The Cardiology Service provider, Dr. Ishmael, will bill for 93010 for the EKG professional interpretation and report.
Dr. Logan will score a Category 2: Independent interpretation of test, which increases the E/M level for MDM Data to moderate or high.

For Dr. Logan to get the independent interpretation credit, she must document that she reviewed the EKG tracing and her professional interpretation of it in the patient’s medical record for that encounter.

A provider who orders, performs, interprets, and bills for the EKG service (93003) cannot also score points for ordering/reviewing that test for E/M MDM Data.

Many of our subscribers have submitted questions surrounding scoring E/M services since the 2021 and 2023 updates. Because of this, we have decided to create a free webinar to answer some of these questions. The webinar entitled "2023 EM QA Live" is scheduled for Thursday, October 12, 2023 @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET. Click HERE to register for this FREE webinar.

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