Billing CPT 93000, 93010 ,93005 - Guideline - Updated

93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers

Whether you call them ECGs or EKGs, chances are you see a lot of electrocardiograms in your practice. That means that even the tiniest coding errors can add up quickly. Brush up on the 93000-93010 basics with this review of the service, the code components, and the role ECGs can play in choosing the proper E/M code.

 Count on These Codes for Proper ECG Reporting

There are three codes for routine ECG:

93000 — Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93005 – tracing only, without interpretation and report
93010  -- Interpretation and report only.

The service these codes describe typically involves placing six leads on the patient’s chest and additional leads on each extremity, says Christina Neighbors, MA, CPC, CCC, ACS-CA, charge capture reconciliation specialist and coder at St. Joseph Heart & Vascular Center in Tacoma, Wash. The procedure “picks up and traces the path of electrical activity sent from the SA [sinoatrial] node through the heart and puts it onto paper,” Neighbors says.

The external skin electrodes can pick up electrical current because the heart’s electrical activity generates currents that spread to the skin.

2. Prevent Denials With This Modifier 26 Rule

Just say no to modifier 26 (Professional component) with your ECG code, warns Kim Huey, CPC, CCS-P, CHCC, an independent coding consultant in Auburn, Ala. Similarly, you should not append modifier TC (Technical component).

Reason: Codes 93000-93010 are already broken down into professional and technical components, Huey says:

93000: global (professional and technical components)
93005: tracing (technical component)
93010: interpretation and report (professional component).


Coverage Indications, Limitations, and/or Medical Necessity

An electrocardiogram (EKG) is a graphic representation of electrical activity within the heart. Electrodes placed on the body in predetermined locations sense this electrical activity, which is then recorded by various means for review and interpretation. EKG recordings are used to diagnose a wide range of heart disease and other conditions that manifest themselves by abnormal cardiac electrical activity.

EKG services are covered diagnostic tests when there are documented signs and symptoms or other clinical indications for providing the service. Coverage includes the review and interpretation of EKG’s only by a physician. There is no coverage for EKG services when rendered as a screening test or as part of a routine examination unless performed as part of the one-time, “Welcome to Medicare” preventive physical examination under section 611 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003.

Electrocardiograms are indicated for diagnosis and patient management purposes involving symptoms of the heart, pericardium, thoracic cavity, and systemic diseases which produce cardiac abnormalities.

An EKG will be considered medically necessary in any of the following circumstances:

1. Initial diagnostic workup for a patient that presents with complaints of symptoms such as chest pain, palpitations, dyspnea, dizziness, syncope, etc. which may suggest a cardiac origin.

2. Evaluation of a patient on a cardiac medication for a cardiac arrhythmia or other cardiac condition which affects the electrical conduction system of the heart ( e.g., inotropics such as digoxin; antiarrhythmics such as Tambocor, Procainamide, or Quinidine; and antianginals such as Cardizem, Isordil, Corgard, Procardia, Inderal and Verapamil). The EKG is necessary to evaluate the effect of the cardiac medication on the patient’s cardiac rhythm and/or conduction system.

3. Evaluation of a patient with a pacemaker with or without clinical findings (history or physical examination) that suggest possible pacemaker malfunction.

4. Evaluation of a patient who has a significant cardiac arrhythmia or conduction disorder in which an EKG is necessary as part of the evaluation and management of the patient. These disorders may include, but are not limited to, the following: Complete Heart Block, Second Degree AV Block, Left Bundle Branch Block, Right Bundle Branch Block, Paroxysmal VT, Atrial Fib/Flutter, Ventricular Fib/Flutter, Cardiac Arrest, Frequent PVCs, Frequent PACs, Wandering Atrial Pacemaker, and any other unspecified cardiac arrhythmia.

5. Evaluation of a patient with known Coronary Artery Disease (CAD) and/or heart muscle disease that presents with symptoms such as increasing shortness of breath (SOB), palpitations, angina, etc.

6. Evaluation of a patient’s response to a newly established therapy for angina, palpitations, arrhythmias, SOB or other cardiopulmonary disease process.

7. Evaluation of patients after coronary artery revascularization by Coronary Artery Bypass Grafting (CABGs), Percutaneous Transluminal Coronary Angiography (PTCA), thrombolytic therapy (e.g., TPA, Streptokinase, Urokinase), and/or stent placement.

8. Evaluation of patients presenting with symptoms of a Myocardial Infarction (MI).

9. Evaluation of other symptomatology which may indicate a cardiac origin especially in those patients who have a history of an MI, CABG surgery or PTCA or patients who are being treated medically after a positive stress test or cardiac catherization.

10. Pre-operative Evaluation of the patient when:

- undergoing cardiac surgery such as CABGs, automatic implantable cardiac defibrillator, or pacemaker, or

- the patient has a medical condition associated with a significant risk of serious cardiac arrhythmia and/or myocardial ischemia such as Diabetes, history of MI, angina pectoris, aneurysm of heart wall, chronic ischemic heart disease, pericarditis, valvular disease or cardiomyopathy to name a few.

11. Evaluation of a patient’s response to the administration of an agent known to result in cardiac or EKG abnormalities (for patients with suspected, or at increased risk of developing, cardiovascular disease or dysfunction). Examples of these agents are antineoplastic drugs, lithium, tranquilizers, anticonvulsants, and antidepressant agents.

12. When performed as a baseline evaluation prior to the initiation of an agent known to result in cardiac or EKG abnormalities. An example of such an agent is verapamil.

Fee schedule

CPT® Code Procedure Description   National Average Fee

93000 Electrocardiogram Routine ECG with at least 12 leads; with interpretation and report $17
93005 Electrocardiogram Routine ECG with at least 12 leads; tracing only, without interpretation and report $9
93010 Electrocardiogram Routine ECG with at least 12 leads; interpretation and report only $9
93040 Rhythm ECG One to three leads; with interpretation and report $13
93041 Rhythm ECG One to three leads; tracing only, without interpretation and report $6
93042 Rhythm ECG One to three leads; interpretation and report only $7

Billing and Coding Guide 

CPT  code 93010 describes the Professional Component only, 93005 describes the Technical Component only, and 93000 describes the global test only. Modifiers TC
or 26 are not used to report these services as they are inherent within the code descriptions.


Electrocardiograms (ECG) (e.g., CPT codes 93000, 93005, 93010) will not be separately reimbursed when submitted with a cardiac stress test (CPT code 93015), a cardiac test that includes an ECG as part of the test, or with initial hospital care. A three-lead ECG is considered incidental to a 12-lead ECG. Separate reimbursement for ECGs that are considered incidental is not allowed. An ECG is considered mutually exclusive to physician services for cardiac rehabilitation (CPT code 93797).

Separate reimbursement for ECGs that are considered mutually exclusive is not allowed. Separate reimbursement for the interpretation of an ECG report (CPT code 93010) will be allowed once for the report officially attached to the EKG. Separate reimbursement is not allowed for 93010 when submitted with the following services: emergency room E/M (CPT codes 99281-99285); or critical care E/M (CPT codes 99291-99292). Interpretation of the ECG report by the attending physician is considered part of the E/M visit.


Under guidelines from the Centers for Medicare & Medicaid Services, an EKG is considered a column 2 code to surgical procedures (surgical procedures are column 1 codes) and as such, an EKG will be disallowed when billed on the same day as a surgical procedure, including minor procedures.

When an EKG is rendered for a diagnosis unrelated to the surgical procedure, it is appropriate to append modifier 59 to the EKG code when CMS indicates a modifier is allowed. The medical documentation must support the use of modifier 59 or payment may be retracted following an audit

93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) and (Rhythm ECG, one to three leads; tracing only without interpretation and report) bundles with A0426 (Ambulance service, advanced life support, non-emergency transport, level I {ALS}), A0427 (Ambulance service, advanced life support, emergency transport, level I {ALS I-emergency}), A0428 (Ambulance service, basic life support, non-emergency transport {BLS}), A0429 (Ambulance service, basic life support, emergency transport {BLS-emergency}), A0430 (Ambulance service, conventional air services, transport, one way {fixed wing}), A0431 (Ambulance service, conventional air services, transport, one way {rotary wing}), A0432 (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), A0433 (Advanced life support, level 2 {ALS 2}), A0434 (Specialty care transport {SCT}), A0800 (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and A0999 (Unlisted ambulance service).


93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report), 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only), 93040 (Rhythm ECG, one to three leads; with interpretation and report) and 93042 (Rhythm ECG, one to three leads; interpretation and report only) bundles with A0426 (Ambulance service, advanced life support, nonemergency transport, level I {ALS}), A0427 (Ambulance service, advanced life support, emergency transport, level I {ALS I-emergency}), A0428 (Ambulance service, basic life support, non-emergency transport {BLS}), A0429 (Ambulance service, basic life support, emergency transport {BLSemergency}), A0430 (Ambulance service, conventional air services, transport, one way {fixed wing}), A0431 (Ambulance service, conventional air services, transport, one way {rotary wing}), A0432 (Paramedic intercept {PI}, rural area, transport furnished by a volunteer ambulance company which is prohibited by state law from billing third party payers), A0433 (Advanced life support, level 2 {ALS 2}), A0434 (Specialty care transport {SCT}), A0800 (Ambulance transport provided between the hours of 7 p.m. and 7 a.m.), and A0999 (Unlisted ambulance service).




2 comments:

Anonymous said...

How much content do you think should be documented to support the professional part of 93000? It is not enough to say NSR - the review is expected and part of the E/M. Any good resources on the interpretation and report?

Anonymous said...

Does the global charge have to be billed as a professional claim, or can it be billed on a UB (institutional) claim?

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