99300 — Electrocardiogram (EKG). Check your covered indications, advises Betsy Nicoletti, president, Medical Practice Consulting, Northampton, Mass. “Either a patient has a covered indication or they don’t,” says Nicoletti. “You can’t make one up.” An example is atrial fibrillation or chest pain.
You also can’t conduct an EKG without medical necessity and expect to get paid for it. “There is no coverage for EKG services when rendered as a screening test or as part of a routine examination,” states Pub 100-03 of the CMS Manual System. In particular, Nicoletti sees practices conduct EKGs during pre-op exams, and that’s not clinically covered.
“If you feel like that patient needs a pre-op EKG and there’s no covered indication, all you can do is say to the patient, ‘Medicare isn’t going to pay for this,’” and offer them an advance beneficiary notice of noncoverage (ABN), says Nicoletti. “Groups don’t like to do that; they’ll eat those [costs].”
Also be sure the physician’s assessment is present. “Often I just see the EKG machine print out,” observes Maxine Lewis, president, Medical Coding and Reimbursement, Cincinnati. “I don’t know if he agrees or disagrees. He has to state that.”