Never bill a rhythm strip interpretation as a substitute for EKG interpretation. Coders bill for rhythm strip interpretation very rarely. To give you a clear perspective of when you would be billing for rhythm strip, here are few examples, suppose you have got somebody on the monitor that has an atrial fibrillation and it's going on a pretty rapid rate, many times, you have to order a rhythm strip. And a rhythm strip would be done many times and most times by the EKG department where the person will come in, come down. We'll hook the person up to the EKG machine. And then run a long rhythm strip. A lot of times, a rhythm strip will be three of those that are next to each other. And you'll do that from the physician perspective. A lot of times, it's really hard to tell the rate on that because what happens is the monitor kind of skips around. And you give the patient the medication called a diltiazem to slow down the heart rate. And the monitor keeps jumping between the 130 and 97, so you have to bring the rate down to above 100 and slow it down to a little smaller degree. So you might order a rhythm strip where you can run that 3.5x11s together where you can actually count.
Another example, if you have heart block patient. A lot of times, second degree heart block is sometimes a very difficult thing to separate. That's called a type one versus a type two. Type two is much more significant because a type two can lead to a complete heart block. So if you have type one though, there's not as big a risk of going into a complete heart block. So, you'd want to order a rhythm strip to really plot out what are called the PR intervals and see if there's any skip beats and that type of thing. Once again, you might very well see a rhythm strip order. What you'll have to visualize is the physician is there with calipers perhaps determining– what type of heart block it is, what type of rhythm it is because sometimes by putting a long rhythm strip can also help you differentiate between a natural fibrillation and a natural flutter. But once again, it is not a monitor strip. It is a separately ordered rhythm strip that's usually done by the EKG department. And they come down and they hook the person up to the EKG machine. However, there are some facilities - and maybe some of you all are at those facilities where they don't have EKG techs or they have their nursing personnel do all of their EKGs, have nursing personnel do rhythm strip if required. But once again, this is unusual to order a rhythm strip. So be very careful with rhythm strip, as it is used very rarely in our industry.
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