Best Practices: Excelling with EKGs

How to Optimize Your Reimbursement: EKG and Cardiac Monitor Interpretations.

Your Successful Reimbursement to be Realized

In Emergency Medicine, it’s easy to overlook the value of the services we provide. At many sites, revenue of $150,000 per year can be generated based on the interpretation of EKGs alone. [1] Similarly, hospital-based Emergency Medicine groups can potentially generate many tens of thousands of dollars annually just based on Cardiac Monitor interpretations. This article will show you how to financially excel in these areas and obtain the appropriate reimbursement for the services you provide.

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Reimbursement for EKG and Cardiac Monitor interpretations is not the same for all practices, with each site being subject to statute, regulations, and / or contractual agreements. This being noted, about 80% of Emergency Medicine practices submit EKG interpretations for financial reimbursement.[^2]

Based on 2018 AMA CPT designations, a 12 lead EKG interpretation (CPT code 93010) generates 0.24 RVUs.[^3] Within the framework of the 2018 Medicare Physician Fee Schedule, this translates to $8.64 per EKG interpretation.[^4] Many insurance carriers reimburse above this amount. Based on a 55,000 patient / year ER volume, consider the following: If you average eight EKG interpretations documented during a typical “main side” shift, you’ve generated $69.12 in the course of that shift. Now, if this site has six comparable shifts per day, that’s $414.72 / day that stands to be realized. Over the course of 365 days, this group’s reimbursement potential is $151,372 for the year.

Similarly, based on 2018 AMA CPT designations, a Cardiac Monitor interpretation (CPT code 93042) generates 0.20 RVUs. Within the framework of the 2018 Medicare Physician Fee Schedule, this translates to $7.20 per interpretation. Some insurance carriers reimburse up to three to four times this amount. In a 55,000 patient per year ER setting: eight Cardiac Monitor interpretations documented during a typical “main side” shift, will generate $57.60. Presuming this site has six comparable shifts per day, that’s $345.60 / day and potentially $126,144.00 per year!

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All You Need to Excel with Your EKGs

1. An order must be placed for the EKG.
2. Documentation must be present that supports the need for this diagnostic test.
3. Three or four of the following elements must be included as part of your EKG interpretation:

• Rate and Rhythm • ST / T abnormalities (or absence)
• Axis • PR / QT intervals
• Atrial / Ventricular hypertrophy • QRS width
• Comparison with previous EKG

Here’s How Your Documentation Should Look

“EKG interpretation: Normal sinus rhythm with heart rate in the 60s. Normal axis. No LVH. No significant ST/T abnormalities are apparent. No significant change compared with the patient’s June 2015 EKG, as interpreted by me.”

Keep in mind, CPT guidelines state that there must be a “separate” report for EKG interpretation. Therefore, best practice is to ensure that your EKG interpretations have their own designated area or at least are within a separate paragraph in your charting.

Strive to Be Crystal Clear

With your EKG and Cardiac Monitor interpretations, it is important to be attentive to the language used in your charting. The phrase “as interpreted by me” is one of best practice. This notation clearly conveys to your coders (and payers) that you performed the work involved with the analysis. Contrast this to the phrase “as reviewed by me.” Charting such a statement implies you simply reviewed a report rather than performed the work involved in the analysis. Don’t disregard this — some payers may deny reimbursement for the service you have provided.

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Not All Sites Will Reimburse for EKGs

CPT guidelines allow for any qualified physician to code for a service they provide. Medicare, as well as some other payers, will reimburse for only one EKG interpretation as applicable for a single diagnostic service. It may happen that multiple providers perform an interpretation on the same EKG. For example, this occurs when the Emergency Medicine physician and the cardiologist reviewing a facility’s EKG both perform an interpretation on the same EKG. The clinician who gets reimbursed in this situation depends upon the policy of your payers, hospital guidelines, and/or contractual arrangements made by your physician group.[^5]

One More Avenue for Success – Cardiac Monitors Interpretations

The Cardiac Monitor interpretation service you provide and its associated reimbursement are separate and distinct from your EKG interpretations.

What Your Cardiac Monitor Interpretations Need

1. An order for the cardiac monitor must be placed by the provider.
2. An interpretation must be made of rhythm and rate.
3. The reason for the cardiac monitor interpretation should be documented.

Keep in mind, some of your Cardiac Monitor interpretations cannot be coded as a “separately reported billable procedure” for a number of your patients to whom you’ve provided billable critical care time. CMS’s “National Correct Coding Initiative” does not permit Cardiac Monitor interpretations to be submitted on Medicare patients toward which critical care services have been rendered.[^6]  Even in the setting of a robust critical care time percentage (for example 10% of patient encounters), over $80,000 can be generated from Cardiac Monitor interpretations.

Three High-Yield Pearls That Will Serve You Well:

• “The cardiac monitor revealed normal sinus rhythm with heart rate in the 80s as interpreted by me. The patient presented with chest pain and the cardiac monitor was ordered to monitor for dysrhythmia.” Statements such as this are the key to your reimbursement success.
• Most Emergency Medicine groups can bill for their EKG interpretations. When local politics dictate otherwise, recall you can still optimize your Cardiac Monitor interpretations. These can very positively impact your financial success.
• Always ensure these diagnostic tests have an actual order. Your coders can’t submit interpretations for billing without one.

References:

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1. ACEP.org : Reimbursement FAQs => X-Ray – EKG FAQs No.1/4; Updated 7/23/15. (Resourced 8/3/18).

2. Granovsky, M. “The Most Common ED Procedures”; ACEP Coding Conference 2018, faculty presentation.

3. AMA Current Procedural Terminology (CPT) 2018 Professional Edition. 4th ed. Revised 2017.
4. 2018 National Physician Fee Schedule Relative Value File, GPCI18, National  Physician Fee Schedule Relative Value File Calendar Year 2018, MCR-MUE-Practitioner Services. Published by CMS. Effective: July 1, 2018.

5. ACEP.org: Reimbursement FAQs => X-Ray – EKG FAQs No.12; Updated 7/23/15. (Resourced 8/3/18).

6. CMS : National Correct Coding Initiative Coding Policy Manual for Medicare Services;   January 1, 2018