CPT code 93268 is used for recording and reviewing an electrocardiogram (ECG), which monitors heart activity over a period.
CPT code 93268 is used for the recording and review of an electrocardiogram (ECG or EKG). This code specifically pertains to the process where a healthcare provider records the electrical activity of a patient's heart over a period, typically using a portable device. The data collected is then reviewed and interpreted by a qualified professional to assess the heart's rhythm and detect any abnormalities. This service is crucial for diagnosing and monitoring various cardiac conditions, ensuring that patients receive appropriate and timely care.
For CPT code 93268, which pertains to ECG recording and review, the following modifiers may be applicable:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the service is being billed. It indicates that the provider is billing for the interpretation of the ECG results, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the service is being billed. It indicates that the provider is billing for the use of equipment and technician services, excluding the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier may be used if the ECG service is distinct or independent from other services performed on the same day. It helps to indicate that the procedures are not bundled and should be reimbursed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is applicable if the ECG service needs to be repeated by the same physician due to medical necessity on the same day.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when the ECG service is repeated by a different physician on the same day, again due to medical necessity.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can be applicable if the ECG is repeated for clinical reasons, not due to equipment malfunction or error.
These modifiers ensure accurate billing and reimbursement by providing additional context about the service provided. It's important to use them appropriately to avoid claim denials or delays.
CPT code 93268, which involves ECG record/review, is generally reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary. Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B. The specific reimbursement rate can vary based on geographic location and other factors, as determined by the local Medicare Administrative Contractor (MAC). Each MAC is responsible for processing claims and ensuring that services billed under CPT code 93268 comply with Medicare's guidelines and policies. Healthcare providers should verify with their respective MAC to confirm the specific reimbursement details and any additional documentation requirements for this code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including specific codes like 93268. Schedule a demo today to see how RevFind can help you identify discrepancies with individual payers and ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
