Tuesday, June 22, 2010

EKGS AND X-RAYS IN THE EMERGENCY ROOM

EKGS AND X-RAYS IN THE EMERGENCY ROOM

Medicare uses the following guidelines when processing claims where both an emergency room
physician and radiologist or cardiologist interpret an X-ray or electrocardiogram done in the ER:

· Specialty is not the primary factor considered when making payment for an
interpretation of an EKG or X-ray done in the ER. Payment is made for the
interpretation and report that directly contributes to the diagnosis and treatment of
the individual patient. The interpretation billed by the cardiologist or radiologist is
payable if the interpretation is performed with the diagnosis and treatment of the
patient or if it is the only bill received. More than one interpretation on the same EKG
or X-ray may be allowable under unusual circumstances.

· The professional component of a diagnostic procedure furnished to a patient in a
hospital includes an interpretation and written report for inclusion in the patient’s
medical record maintained by the hospital. The interpretation and report of the
procedure is separately considered. A “review” of the findings of these procedures,
without a written report, does not meet the conditions for separate payment of the
service since the review is already included in the ER visit. A physician must dictate
and sign a formal report in the same fashion as a typical radiology or cardiology
report. It should contain the usual pertinent patient identification, time of the
procedure, a description of the study, findings, comparisons and conclusions or
impressions and necessary follow-up. A hand written note in the emergency room
record and/or a simple review without a written report is not acceptable.

· Hospitals are encouraged to work with their medical staff to ensure that only one
claim per interpretation is submitted. Medicare Part B may determine that the
hospital’s “official interpretation” is for quality control and liability purposes only and is
a service to the hospital rather than to an individual patient. Separate payment for
interpretations that are performed solely for quality control purposes will not be
considered.

Note: Only one payment can be made for a specific report dictated either by the physician in
the emergency room or the hospital radiologist (or cardiologist) but not both. If questions
arise as to correct billing, they should be worked out internally by the hospital’s medical
staff and administration before incorrect claim submissions are made.

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