tci ED Coding & Reimbursement Alert - 2011 Issue 12

Reader Question: Be specific with the diagnosis to show ECG Claim medical necessity

Question: What codes should we use to report diagnostic electrocardiography (ECG) tests? And how can we prove medical necessity for these tests? We have gotten several recent "medically unnecessary" denials on ECG claims. Minnesota SubscriberAnswer: Emergency physicians often order ECGs based on presenting symptoms to determine whether the patient has a cardiac problem. Payment for this diagnostic test often depends on whether you can prove medical necessity. Choose an ICD-9 code that tells the payer exactly why the emergency physician needed to perform the service. If your diagnosis code is not specific enough, payers may balk at accepting your...

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