Saturday, August 22, 2020

CPT code 93000, 93040, 93041, 93042, 93010 - ECG and EKG codes

 CPT® Code Procedure Description  

93000 Electrocardiogram Routine ECG with at least 12 leads; with interpretation and report  

93005 Electrocardiogram Routine ECG with at least 12 leads; tracing only, without 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  

93041 Rhythm ECG One to three leads; tracing only, without interpretation and report  

93042 Rhythm ECG One to three leads; interpretation and report only

CPT Manual Instructions for Reporting Electrocardiographic Recording

• Codes 93040-93042 are appropriate when an order for the test is triggered by an event, the rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is generated.

• There must be a specific order for an electrocardiogram or rhythm strip followed by a separate, signed, written, and retrievable report.

• It is not appropriate to use these codes for reviewing telemetry monitor strips taken  from a monitoring system.

• The need for an electrocardiogram or rhythm strip should be supported by  documentation in the patient medical record.

Bundled Services per CPT Manual

• Do not report 93040-93042 when performing 93279-93289, 93291-93296, or  93298-93299

Report proper ICD-10-CM diagnosis codes to support the medical necessity for the use of an ECG. ICD-10-CM codes and/or ranges are provided below to help with your decision process.


Codes 70010-79999, 93000-93010, and 0178T-0180T are used for reporting radiology procedures.


-26 Professional Component

-76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care  Professional

-77 Repeat Procedure by Another Physician or Other Qualified Health Care  Professional

-ET Emergency services

Policy Statement

Medical Imaging and Electrocardiogram (ECG/EKG) Interpretation

Payment will be made for only one interpretation of any given x-ray, CT, MRI, ultrasound or ECG/EKG. Subsequent interpretations or readings by another physician (indicated by the -77 modifier) will not be covered. A re-interpretation by another physician is considered an integral part of the primary physician's medical care.

However, if the patient's condition warrants an immediate interpretation of an imaging study (emergency treatment -ET modifier), payment may be made to the attending or admitting physician even when a hospital staff physician also performs an imaging study interpretation.


• Include documentation in the patient’s records to indicate medical necessity for a separate service.

• Confirm that proper ICD-10-CM diagnosis codes are reported to justify medical necessity of ECG monitoring.

• When appropriate, a modifier may be reported and support documentation should be provided with the claim.

• Some payers may have specific requirements for using certain codes, including prior authorization, restricted medical diagnoses or specialty provider types.


Indications and Limitations of Coverage

Nationally Covered Indications

The following indications are covered nationally unless otherwise indicated:

** Computer analysis of EKGs when furnished in a setting and under the circumstances required for coverage of other EKG services.

** EKG services rendered by an independent diagnostic testing facility (IDTF), including physician review and interpretation. Separate physician services are not covered unless he/she is the patient's attending or consulting physician.

** Emergency EKGs (i.e., when the patient is or may be experiencing a life threatening event) performed as a laboratory or diagnostic service by a portable x-ray supplier only when a physician is in attendance at the time the service is performed or immediately thereafter.

** Home EKG services with documentation of medical necessity.

** Transtelephonic EKG transmissions (effective March 1, 1980) as a diagnostic service for the indications described

below, when performed with equipment meeting the standards described below, subject to the limitations and conditions specified below. Coverage is further limited to the amounts payable with respect to the physician's service in interpreting the results of such transmissions, including charges for rental of the equipment. The device used by the beneficiary is part of a total diagnostic system and is not considered DME separately. Covered uses are to:

o Detect, characterize, and document symptomatic transient arrhythmias;

o Initiate, revise, or discontinue arrhythmic drug therapy; or,

o Carry out early post-hospital monitoring of patients discharged after myocardial infarction (MI); (only if 24- hour coverage is provided, see below).

Certain uses other than those specified above may be covered if, in the judgment of UnitedHealthcare, such use is medically necessary.

Additionally, the transmitting devices must meet at least the following criteria:

** They must be capable of transmitting EKG Leads, I, II, or III; and,

** The tracing must be sufficiently comparable to a conventional EKG.

24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI is only covered if provision is made for such 24-hour attended coverage in the manner described here: 24-hour attended coverage means there must be, at a monitoring site or central data center, an EKG technician or other non-physician, receiving calls and/or EKG data; tape recording devices do not meet this requirement. Further, such technicians should have immediate, 24-hour access to a physician to review transmitted data and make clinical decisions regarding the patient. The technician should also be instructed as to when and how to contact available facilities to assist the patient in case of emergencies.

ICD-10-CM Description

ICD-10-CM Code/ Range

Abnormalities of heart beat R00.0-R00.9

Angina pectoris 120.0-120.9

Atherosclerotic heart disease I25.10-I25.119

Atrioventricular and left bundle-branch block 144.0-144.7

Cardiac arrest I46.2-I46.9

Cardiac murmurs and other cardiac sounds R01.0-R01.2

Cardiomyopathy I42.0-I42.9

Cardiomyopathy in diseases classified elsewhere I43

Essential (primary) hypertension I10

Gangrene, not elsewhere classified I96

Hypertensive heart disease I11.0-I11.9

Multiple valve diseases I08.0-I08.9

Old myocardial infarction I25.2

Other acute ischemic heart diseases I24.0-I24.9

Other cardiac arrhythmias I49.0-I49.9

Other conduction disorders I45.0-145.9

Other pulmonary heart diseases I27.0-I27.9

Pain in chest R07.1-R07.9

Rheumatic aortic valve diseases I06.0-I06.9

Rheumatic mitral valve diseases I05.0-I05.9

ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I21.0-I21.4

Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I22.0-I22.9

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