Triple-S considers for payment an EKG (code 93000) prior to a ambulatory procedure and under intravenous sedation, only in high-risk patient’s risk, example:
A. Severe cardiovascular problems:
1) angina pectoris
2) history of arrhythmias
3) cardiac dysfunction
4) myocarditis
5) patients with permanent pacemakers or implanted defibrillators
B. Conditions Associated With, or Increased Risk of Disease cardiovascular:
1) advanced age > 45 years of age
2) diabetes
3) hyperlipidemia
4) smoking
5) lung diseases
6) peripheral vascular diseases
7) hypo and/or hyperthyroidism
8) collagen diseases
9) muscular dystrophies
10) liver or kidney failure
11) electrolyte disorders
12) morbid obesity (double or increase of 100lbs. of the ideal weight)
C. Use of drugs that carry the potential for cardiac toxicity:
1) antineoplastic drugs
a) doxorubicin
b) Epirubicin
c) Daunorubicin
d) Idarubicin
e) Pyrubicin
2) lithium
3) phenothiazides
4) tricyclic antidepressants
5) erythromycin
D. Neurological disorders
1. Autonomic Neuropathies
2. Documentation:
The justification for performing the EKG must be duly documented in the patient file. If it is not included, it will be considered as absence of medical necessity and payment will not be considered.
