1. EKG services are covered diagnostic tests when there are documented signs and symptoms or other clinical indications for providing the service. EKG services should not routinely be performed as part of a preventive exam unless the member has signs and symptoms of coronary heart disease, family history or other clinical indications at the visit that would justify the test.
2. Billing separately from the interpretation of ECG made and ordered as part of a visit or consultation is considered for payment.
3. The insured is not responsible for payment, when the EKG is denied for not being medically reasonable.
4. Code 93041 (Rhythm plotting; no interpretation, no report) is considered for payment only to authorized suppliers.
5. The production of the plot, if done in the office of a doctor and another provider (also a participant) interprets it, will be paid to the first, the production (93005) and to the second the interpretation (93010).
6. If the code 93041 is produced in the hospital, it is not considered for payment, since the production of the code 93041 is a covered service in the hospital contract.
7. Electrocardiographic monitoring is considered for payment at:
a) Arrhythmias; or at the beginning of any treatment therapy for arrhythmias.
b) As a treatment to monitor:
1) pulse irregularities
2) chest pain
3) palpitations
4) tachyarrhythmias
5) bradyarrhythmias
6) syncope
Electrocardiograms associated with the Stress Test and the Holter
Billing codes 93000-93010 (electrocardiogram) are included in the payment of the Holter (93224) and in the stress test (Stress Test 93015). If you have performed an electrocardiogram within a period of six weeks prior to the Holter or Stress Test, payment of the electrocardiogram will be denied when invoiced with these services.
Electrocardiograms associated with echocardiograms
Triple-S does not consider “rhythm strips” (ECG code 93040, 93042) for payment, since they are considered an integral part of monitoring during the echocardiographic procedure. If EKG 12 “lead” is made and documented separately from 93307, it proceeds for payment.
