Electrocardiogram Performed in the Emergency Department

Effective May 1, 2005, HMSA will make separate payment for the interpretation of an electrocardiogram (ECG) performed in the Emergency Department (ED) by an ED physician.

Limitations

• HMSA will cover only one ECG interpretation and report per member, per service date, where the place of service is emergency room, even though multiple readings may be done.
• Like Medicare, it is HMSA’s intent to cover the interpretation and written report that directly contributed to the diagnosis and treatment of the member.
• The interpretation and report should address the findings, relevant clinical issues and comparative data (when available). A routine notation in the ED notes indicating “EKG normal” does not meet HMSA’s criteria for separate payment of ECG interpretation and report.
• If more than one claim is received for the interpretation and report of an ECG for the same patient, on the same day, where the place of service is emergency room, HMSA will pay plan benefits for the first claim received. Claims received subsequent to this initial payment will be denied.

Revision History