CPT Code 93000 Description | EKG Interpretation CPT Code

Heart disease is the leading cause of death in the USA. According to the American Heart Association, around 121.5 million adults in the country, or 48% of the population, are living with cardiovascular disease. Hence, it doesn’t come as a surprise that electrocardiography or electrocardiogram is one of the most used diagnostic tests in the country. More than 300 million screenings are done annually in the USA.

With the popularity of this diagnostic test, it becomes vital for us to understand all cardiography procedure codes and their guidelines to ensure accurate reimbursements. So, let’s start with CPT code 93000 and deep dive into its real-world applications, modifier usage, billing best practices, and more.

Table Of Contents

CPT Code 93000 – Description
Scenarios Where CPT Code 93000 is Applicable
Applicable Modifiers for CPT Code 93000
CPT Code 93000 – Billing & Reimbursement Guidelines
Summary

CPT Code 93000 – Description

The Current Procedural Terminology (CPT) code 93000 is a cardiography procedure code that explains a heart screening using an electrocardiogram (EKG/ECG) machine. During the screening, the healthcare provider places 12 electrodes on different body parts and attaches the leads/wires to a monitor or recording device to record the heart’s electrical activity. The signals are interpreted and documented to diagnose abnormalities in the heart’s functioning.

A healthcare provider may order this routine or complete electrocardiography if he suspects the patient to be living with a coronary heart disease. Please note that the standard 12-lead EKG is typically performed while the patient is lying still and quietly on the bed. Hence, it is also known as a resting EKG.

Like all the other CPT codes, 93000 is also maintained by the American Medical Association (AMA) under the Cardiography Procedures range. Medicare’s current CPT code 93000 reimbursement rate is between $12.50 and $19.00, depending on the MAC locality and facility.

Scenarios Where CPT Code 93000 is Applicable

From routine and prevention screenings to emergency diagnosis, a primary care physician or a cardiologist may order a complete 12-lead electrocardiogram for several reasons. Let’s look at some real-world examples where CPT code 93000 can be applied for accurate reimbursements.

Emergency ECG/EKG to Diagnose Acute Pulmonary Embolism

Imagine that a patient with irregular heartbeat, shortness of breath, and chest pain visits emergency department. The patient is between 50 and 60 years of age and has a family history of blood clotting disorders. The attending physician suspects that a blood clot in the pulmonary artery is obstructing blood flow to the lungs (pulmonary embolism) and causing the visible symptoms.

An emergency electrocardiogram is ordered for confirmation. The physician uses 12 leads to detect heart strain at various locations on the body, and the results indicate a blockage in the artery. Hence, CPT code 93000 will be used to report the ECG/EKG performed at an emergency department to rule out a heart attack.

Routine ECG/EKG to Detect Potential Coronary Heart Diseases

Before we dive into this scenario, please note that Medicare does not cover an ECG if used for a routine physical examination or screening.

Now, imagine that a patient with private medical insurance undergoes a routine 12-lead electrocardiography to rule out any potential coronary heart diseases. He may have been recommended an ECG because of risk factors like a family history of heart attacks, old age, and obesity. This resting ECG may be performed at an outpatient hospital or office setting.

The provider will monitor the patient’s heart rate and rhythm to check for possible heart damage for up to 15 minutes, document the findings, and report it with CPT code 93000.

Follow-Up ECG/EKG to Manage Existing Coronary Heart Disease

Again, Medicare will not reimburse CPT code 93000 if the purpose of the follow-up electrocardiography is precautionary. However, an ECG may be performed to detect new plaque buildup in the heart arteries if a patient with existing coronary heart disease (or ischemic heart disease) visits his physician complaining of chest pain and dizziness. In this case, the 12-lead ECG/EKG will become medically necessary and reimbursable by Medicare.

The provider will use the test results to revise the patient’s treatment plan and efficiently manage his coronary heart disease.

Applicable Modifiers for CPT Code 93000

Depending on the situation, you may append the following modifiers with CPT code 93000 to justify the billed amount on your claims.

Applicable Modifiers	Descriptions
25	Modifier 25 must be used with CPT code 93000 if a separate and unrelated E/M service was rendered on the same day as the ECG to the same patient by the same provider. Note that the code already covers E/M services related to the electrocardiogram.
26	Modifier 26 is appended with the EKG interpretation CPT code 93000 to indicate that the healthcare provider only performed the professional component of the service (interpreted and reported the results).
59	Modifier 59 must be appended if two separate and distinct procedures were performed on the same day, on the same patient by the same provider, e.g., a 3-lead ECG and a 12-lead ECG. It unbundles the services that are typically considered part of the same procedure and ensures separate payments.
76	Modifier 76 should be appended with CPT code 93000 if the same provider repeated the procedure on the same day. Reasons for a redo may be a technical failure on the first try or obtaining more readings for increased accuracy.
77	Modifier 77 indicates that a different healthcare provider repeated the electrocardiography on the same patient on the same day. The reason could be that the first provider could not obtain accurate readings.
91	Modifier 91 can be appended with CPT code 93000 if the electrocardiography was repeated on the same day for clinical reasons. For example, to obtain additional information. This modifier is usually used for repeat clinical diagnostic laboratory tests to get new data.
TC	CPT code 93000 covers the technical and professional components of an electrocardiography. However, modifier TC should be used if the provider performs the technical component of the test and the results are interpreted by another physician. It ensures reimbursement for the technician’s equipment and time.

CPT Code 93000 – Billing & Reimbursement Guidelines

Just knowing the details of CPT code 93000, its best use cases, and applicable modifiers is not enough to guarantee a clean claim submission. You must also be aware of its billing best practices to collect complete reimbursements on time. Below, we have explained some dos and don’ts for reporting CPT code 93000 to help you avoid 93000-related denials.

Report CPT Code 93000 Once per Diem

CPT 93000 is a complete testing code. According to Medicare’s CPT code 93000 reimbursement guidelines, complete testing codes, including 93000, can only be reported once per day, per recipient, and per occurrence. It does not matter if different providers repeat the same electrocardiogram because Medicare will only reimburse it once. It is because Medicare believes that a single screening is sufficient to diagnose and treat a disease.

Submit Detailed Documentation

All insurance payers (Medicare, Medicaid, and commercial ones) will require you to submit comprehensive documentation to prove the medical necessity of the ECG. This may include the patient’s medical history, clinical notes detailing the patient’s symptoms and reasons for the ECG, referral letter, and ECG test report. In the case of Medicare claims, the document collection and submission process for CPT code 93000 will be tedious because Medicare does not cover routine or follow-up electrocardiography unless the patient experiences symptoms.

Do Not Bill Technical and Professional Components Separately

CPT code 93000 is called a complete test code because it covers the technical (TC) and professional components (PC) of the procedure. So, you should not bill the electrical conduction test and its interpretation and reporting separately for a higher reimbursement. However, as explained above, if a technician and a physician were separately involved and handled their respective parts of the test for clinical reasons, it must be justified through modifiers 26 and TC.

Do Not Report for Routine Screenings when Submitting to Medicare

Do not submit a claim with CPT code 93000 to Medicare if the purpose of the ECG was to prevent possible coronary heart disease or related disorders. Medicare does not cover routine EKGs or second readings/ interpretations for preventive reasons. The patient must exhibit symptoms that necessitate monitoring the heart’s electrical activity using 12 leads for Medicare reimbursement.

Append Modifiers when Necessary

As advised in the sections above, you must append appropriate modifiers when needed to offer more insight into the procedure and its surrounding circumstances. The modifiers can help you bypass payers’ strict policies for billing CPT code 93000 by leveraging the exceptions.

For example, even though you are not allowed to bill two complete electrocardiograms on the same day, especially if one ECG test (e.g., 3-lead ECG) is already covered by the other ECG screening (e.g., 12-lead ECG), you can append modifier 59 to explain that the two tests were distinct, medically necessary, and separately billable.

Summary

To wrap up today’s detailed guide on cardiography CPT code 93000, let’s summarize what we learned and leave you with key takeaways. We explained that CPT 93000 reports an electrocardiogram (ECG/EKG) to monitor the heart’s electrical activity and detect problems with the organ’s normal functioning. The code covers ECG monitoring, results interpretation, and reporting.

Next, we looked at some scenarios where code 93000 is applicable, such as an emergency ECG, routine ECG, and follow-up ECG. We also listed the modifiers that are commonly appended with CPT code 93000 and listed some billing best practices to improve the clean submission rate for 93000-related claims.
While knowledge is power, some things are better left to experts. MediBillMD’s cardiology billing services include specialty-specific CPT coding, helping you navigate 93000’s coding challenges, leading to an increased bottom line.

Frequently Asked Questions

Is CPT code 93000 covered by Medicare?

Yes. Medicare covers CPT code 93000 reimbursement, given that the electrocardiogram was medically necessary and ordered by a qualified healthcare provider (usually the patient’s cardiologist). Medicare also provides a list of ICD-10-CM codes that support the medical necessity of reporting this CPT code, e.g., A18.84 – tuberculosis of the heart or A40.3 – sepsis due to Streptococcus pneumoniae.

What is the age limit for CPT code 93000?

CPT code 93000 is not age-specific. A patient from any age group or gender can undergo a standard electrocardiogram. However, the U.S. Preventive Services Task Force does not recommend coronary disease screening for patients under 18 years of age. Moreover, it mandates that the test be performed in an office setting (POS 11) and only on adults who experience symptoms of coronary heart disease.

What is the difference between CPT codes 93000 and 93010?

The key difference between CPT codes 93000 and 93010 is that the former reports the technical and professional components of an electrocardiogram. The provider performs the test, interprets the results, and prepares a report to make CPT code 93000 valid. However, CPT code 93010 only covers the professional component of the test, meaning he interprets the results from 12 leads and documents them.

Can 93000 and 93015 be billed together?

No. You cannot bill CPT codes 93000 and 93015 on the same date of service for the same patient and provider because both are complete testing codes and are reimbursable only “once per recipient, per day, any provider, per occurrence”. The payer may reduce the payment of the other code or deny the claim if 93000 and 93015 are billed for the same patient and provider on the same service date.

Can CPT 93000 and 93040 be billed together?

Under normal circumstances, CPT codes 93000 and 93040 should not be billed as separately identifiable screenings performed on the same service date because both are considered overlapping/bundled procedures. Medicare states that “a rhythm ECG tracing (93040 or 93041) is included in a 12-lead ECG tracing (93000 or 93005)”.

However, if the provider intended to perform only 93040 (ECG with 3 leads) and proceeded to perform 93000 (ECG with 12 leads) for more clarity, modifier 59 should be appended with CPT code 93000 to report it as a separate and distinct procedure.

Can you bill 93000 and 99211 together?

As per Medicare’s NCCI edits, electrocardiogram CPT code 93000 should not be reported with the E/M service code 99211 because 93000 covers pre-procedure, intra-procedure, and post-procedure work, so the evaluation and management service rendered by a nurse or physician’s assistant is included in the EKG code. However, if the E/M service is separately unidentifiable (or unrelated to EKG), you must append modifier 25 with code 99211 for separate billing.