The interpretation of any diagnostic tests or study performed in the conjunction with the patient visit should be reported, in addition to the appropriate E/M service. There are a number of things that emergency physicians do interpret and that varies between state, region and what groups are billing for. The Interpretation of X-ray or EKG does not does contribute to the diagnosis or treatment of the emergency patient that is not deemed to be medically necessary and not reimbursable. In many cases, an interpretation of an EKG is done if its 100% necessary for that particular case. If you see any subtle changes on EKG, it indicates that the person is having some underlying coronary or artery disease that could be a rhythm problem with the heart itself.
Some patient comes in complaining of things such as chest pains for getting a cardiogram. There are a number of reasons why you order an EKG including abdominal pain. Patient complaining about coronary pain could be presented in multiple ways. So once again, order an EKG or interpretation of EKG is done by the emergency physician 100% of the time. It's very rare that another physician interprets it for the emergency physician. When we talk about medical necessity while looking at EKGs or x-rays, you know, you're ordering them specifically because it's going to aid in your diagnosis. Now, an interpretation performed by a cardiologist or radiologist contemporaneous would supersede with the emergency physician. And it’s rare to have a cardiologist contemporaneously review that cardiogram. Approx 98% of the time, that EKG is reviewed after the patient is gone, whereas a radiologist had different story because between the hours of 7:00 to 8 o'clock in the morning until around 5 o'clock in the afternoon, you might very well get a reading of an x-ray that would be done by a radiology, whereas after 6:00 pm or on weekends, it's uncommon to get a contemporaneous reading of your x-rays.
EKG is usually 100% across the board. The emergency physician is doing the initial interpretation. And it is contemporaneous with the patient here. Very rarely does a cardiologist provide that reading at the time of patient care or contemporaneous with the patient visit whereas radiology, that can occur usually doing daytime hours, can occur certainly in the evening but only when that particular physician has been asked to look at that. Routinely that would not be done. Interpretation is provided days or hours after the patient is sent home, which doesn’t meet the requirements for contemporaneous reading. Any interpretation that's not performed contemporaneous is not medically necessary. It's interesting in the practice of emergency medicine, where you have to interpret a cardiogram. But there are certain requirements that the physician does that the hospital provides the over-read of that EKG.
Is it required across the board? Well, sometimes for different certifications, e.g. hospital. You know, you'd want to have your EKGs and X-rays over-read by the radiologist. So whether it's medically necessary or not at the time of visit but certainly for oversight of the interpretations that may very well be necessary. When we're talking about EKG and X-ray interpretations, there's a lot of political influence, because of the way the mandates or regulations were written many years ago, related to EKG interpretations, the hospital has an interesting role in here where they help decide who primarily bills for EKG interpretations and also provides for, the initial reading of x-rays themselves. And there are many times that the cardiologist will bill for this in the 93010 primarily versus the emergency physician who's reading and contemporaneous. This is not, 50% across the board, 60%, 70%. It really does vary but majority of emergency physicians do bill for the 93010 primarily, whereas, in some locations, cardiologists do bill for it primarily. But it's probably about 80% of the time it is billed primarily by the emergency physician.
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