When it comes to interpretation of EKGs, an EKG is printed out from the EKG machine. There are 12 leads involves with an EKG. But when it prints out, it prints out with the 12 leads and it has rhythm strips underneath it. So if you have a copy of EKG and you have the emergency physician who has made a comment and then sign their name, you'll notice intervals there. The lengths have appeared and all of the QRS or QTC, the ST segment, are listed there. And any changes, the old Q waves as an example would all be listed using the left upper quadrant of cardiogram. And when you talk about the rhythm itself and the rate is incorporated in the cardiogram too. It’s imperative to have a copy of the cardiogram that the emergency physician has signed and that would have any changes on that the physician differed with the initial interpretation of the cardiogram.
For instance, you have an EKG that reveals a sinus tachycardia at a rate of 120 with nonspecific ST/T wave changes. That means– you got a rate and a rhythm, and nonspecific changes. That is a very common way, a common phrase if you will for an interpretation of that EKG. Another one might be EKG with normal sinus rhythm at a rate of 76 with elongated PR interval of .22 seconds, and with no acute ST/T wave changes. Another example would be an (inaudible) cardiogram and evaluation, to pronounce somebody dead and you got a rhythm strip that show a rhythm or the EKG which you normally would have a (inaudible) would be one example. Another important example would be ventricular fibrillation. If you have that – there's really not much else you have to that. If you have a paced rhythm and have someone that has a pacemaker inserted, you might very well only have paced rhythm on the EKG interpretation that should be acceptable. Another example would be ventricular tachycardia or V-tach at a rate of 150 as an example. You know, that may be all you see on that cardiogram because again a rhythm is what's driving that cardiogram. And so, again, you might see that as an example. Couple other examples might be an EKG with bradycardia, sinus bradycardia at the rate of 52 with ST segment elevation 23 in (AVF) with the score and depression of 82 through V4 indicating an acute inferior MI.
Some more examples which could relate to the situation –provided you have the rate rhythm and you're going to have a comment related to the ST segments because that’s really what – and you might have a talk about the T wave whether it's inverted or a peak test we talked about. So once again, there's a lot of things on an EKG you're looking at. If you have three out of nine, that should give you enough comfort to go ahead and be billing for that. Let’s take a look at the rhythm strip interpretation, which is done very uncommonly or billed for now in our industry. Why is that? Because January 1 of '08 when the new CPT manual came out over a year ago, they had different language related to the rhythm strip interpretations. Basically, if I were to review that, the one main thing is it's not appropriate to use these codes for reviewing that to limitary monitor strips taken from a monitoring system. So different companies would go for a rhythm interpretation if the physician documented my review or the monitor shows a normal sinus rhythm or my review of the monitor shows an atrial fibrillation with the rapid ventricular response as an example.
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