ED Coding and Compliance: Get the Specifics on EKG and X-Ray Diagnostic Interpretations


 

Diagnostic interpretations were effective January 1, 1996 where Medicare required that x-rays and EKGs appear as a separate notation in the medical record. It's good to have that happily because it is a separate service that’s being provided. There are payers unhappily that decide among themselves that they incorporate that with the E/M code. But that is certainly not the proper way to adjudicate these medical coding claims, et cetera. But having said that, that's just part really part of the process and part of the problems that goes on in doing effective billing, et cetera.

So we do know that when you're doing an interpretation of an EKG, when you're doing an interpretation or billing for x-ray interpretations, you would bill for them separately from your evaluation of management code as per the medical coding rules.

Now, when we're talking about what you need on the chart, what do you need to have it documented, you know, it's important to note that you really didn’t have – you know, you don’t do not need to have a separate document. But the written reports can definitely be incorporated into the emergency department treatment record. But, as the medical coding rules require, it really has to clearly refract in the interpretation and not a review of an interpretation.

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What we mean different was by that is this, is that when you do you have a written report does not have to be separate from the treatment record. It can be incorporated into the treatment record. But it has to designate with the emergency physician. They didn’t interpret that. And that the interpretation is written there was provided by the emergency physician. So that's different than writing down an interpretation done by another physician.

Let us give you a couple of medical coding and billing examples of that. Let's say that you are seeing a person that you done the EKG interpretation. You will then write down your interpretation of that normal science where there were no acute ST/T wave changes with the rate of 85 or something along those lines. Or you may say, “Okay, I've got this patient that has a severely sprained ankle. You visualize when you are taking at a look at that x-ray. But you are waiting for the official x-ray report from the radiologist. You might have incorporated in my treatment record that you visualize the x-ray and did not see any fracture or subluxation or dislocation and the radiologist via their report concurred with me. That's one example.

Another medical coding and billing example may be – you know, another example of a review might be x-ray radiologist interprets the x-ray as being negative for fracture, dislocation or subluxation, period. So once again, the interpretation would indicate that the emergency physician was the one that did provide that interpretation primarily whereas a review of an interpretation would be sort of a summary of what the radiologist found in very, very rarely – it would be the summary of what the cardiologist knows.

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