As a reminder, claims for EKGs (CPT code 93000) that are filed in conjunction with a member’s annual wellness exam, AND where there were no other diagnoses on the claim line for the EKG that would justify the testing, will not be separately reimbursed.

Guidelines from the U.S. Preventive Services Task Force (USPSTF) (2011), the American Academy of Family Physicians (AAFP) (2011), the American College of Cardiology (ACC) Foundation (2010), and the American Heart Association (AHA) (2010) advise against electrography in asymptomatic, low-risk individuals.

To note the following:

• There is little evidence that detection of coronary artery stenosis in asymptomatic patients at low-risk for coronary heart disease improves health outcomes.
• False-positive tests are likely to lead to harm through unnecessary invasive procedures, over-treatment, and misdiagnosis.
• Potential harms of this routine annual screening exceed the potential benefit.

The AHA compiled data, including information from the Framingham Heart Study, to determine appropriate use of cardiac screening tests by looking at prognostic considerations. Those risk factors include gender and age (males over the age of 45 years) with one or more risk factors. The greater the number of risk factors a patient has, the more likely it is that the patient will benefit from a screening. If a patient’s risk is less than 10 percent [calculated using a risk assessment tool) a screening is not recommended.

The USPSTF reviewed new evidence regarding the reduction of risk for coronary heart disease (CHD) events in asymptomatic adults by screening with electrocardiography (EKG) compared with not screening, and issued the following recommendations: They recommend against screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at low risk for CHD events (D recommendation). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG for the prediction of CHD events in asymptomatic adults at intermediate or high risk for CHD events.

Please see the full text of the new EKG during a preventive exam here.