Cardiology Billing for ED EKGs is Trash

[DeadCactus]

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That’s it. That’s the post.

Seriously though, I don’t understand why this is a thing at some institutions unless they are reading them in real time at 3 AM.

What am I missing?

 

[Vandalia]

Essentially the same thing as radiology providing and billing for an interpretation of the plain film in the morning that you read and acted on the night before.

In theory, it should mean that both take the liability for missing a subtle chronic finding. Or a huge finding. Again, theory.

In practice, the cardiology group has the concession to read every EKG done at the facility.

Before many of you were born, I was moonlighting at a civilian ED and placed a foley in a patient. About a half-hour later I had a urologist who bore a striking resemblance to Boss Hog a few inches from my face screaming at me "YOU JUST TOOK FIFTY DOLLARS OUT OF MY POCKET!!"

Same basic idea.

 

[HemorrhagicShock]

Pretty simple at my institution. Hegemonic revenue-generating specialty doesn't want to give up a steady stream of income. Revenue-generating specialty (who also brings their patients and procedures to said institution) has the political capital to keep it that way. Revenue-generating specialty knows they can continue to get away with this because when they threaten to walk, the hospital will instantly bend.

 

[Birdstrike]

That’s it. That’s the post.

Seriously though, I don’t understand why this is a thing at some institutions unless they are reading them in real time at 3 AM.

What am I missing?

What you're missing is that you are interpreting the EKGs and choosing not bill for them. Cardiology is walking behind you and picking up your scraps, that you're willingly giving to them. You're literally putting money in their hand and getting mad at them for taking it.

It pays about $8 to interpret an EKG. It doesn't sound like much, if you do it contemporaneously. But if you wait and gather up a bunch and bill for them in batches, all of a sudden, you're talking about real money. Cardiology would be dumb not to collect your 93010s that you throw away. They're happy to sit and read about 120 in a short period of time and make $1,000, with near zero risk. After all, it's cheese they've never known an ED doc to ever care enough to be hungry for.

If you want that money, it absolutely is your right to bill for the EKGs you're interpreting. There's no reason you can't do it on the fly, or after the fact. But you've gotta actually do it. And you've got to do it before Cards does, because insurance will only pay that code once per tracing.

Here's how >>> How To Get Paid For Reading Your EKGs

 

[DeadCactus]

Essentially the same thing as radiology providing and billing for an interpretation of the plain film in the morning that you read and acted on the night before.

In theory, it should mean that both take the liability for missing a subtle chronic finding. Or a huge finding. Again, theory.

In practice, the cardiology group has the concession to read every EKG done at the facility.

Before many of you were born, I was moonlighting at a civilian ED and placed a foley in a patient. About a half-hour later I had a urologist who bore a striking resemblance to Boss Hog a few inches from my face screaming at me "YOU JUST TOOK FIFTY DOLLARS OUT OF MY POCKET!!"

Same basic idea.

Radiology provides real time reads at my hospital but even when I worked in places where they didn't, they are covering a much wider realm of incidental findings and generally call the patient with updated results.

Pretty simple at my institution. Hegemonic revenue-generating specialty doesn't want to give up a steady stream of income. Revenue-generating specialty (who also brings their patients and procedures to said institution) has the political capital to keep it that way. Revenue-generating specialty knows they can continue to get away with this because when they threaten to walk, the hospital will instantly bend.

Yea, this is the tradeoff to being in a specialty not tied to a practice. I knowingly made the choice but somedays just need to complain.

What you're missing is that you are interpreting the EKGs and choosing not bill for them. Cardiology is walking behind you and picking up your scraps, that you're willingly giving to them. You're literally putting money in their hand and getting mad at them for taking it.

It pays about $8 to interpret an EKG. It doesn't sound like much, if you do it contemporaneously. But if you wait and gather up a bunch and bill for them in batches, all of a sudden, you're talking about real money. Cardiology would be dumb not to collect your 93010s that you throw away. They're happy to sit and read about 120 in a short period of time and make $1,000, with near zero risk. After all, it's cheese they've never known an ED doc to ever care enough to be hungry for.

If you want that money, it absolutely is your right to bill for the EKGs you're interpreting. There's no reason you can't do it on the fly, or after the fact. But you've gotta actually do it. And you've got to do it before Cards does, because insurance will only pay that code once per tracing.

Here's how >>> How To Get Paid For Reading Your EKGs

I don't think me unilaterally deciding to enter charges in disregard to institutional politics is going to go over well. It's tempting to look into though. I don't even care about the billing, I'm just annoyed some frequently poorly mannered clown is collecting money for their valueless input with no real risk or responsibility.

Edit: That ACEP link is great, thanks for sharing.

 

[RoyBasch]

Radiology provides real time reads at my hospital but even when I worked in places where they didn't, they are covering a much wider realm of incidental findings and generally call the patient with updated results.

Heh, everywhere I've worked they just call the ER and we have to deal with it entirely.
radiology does not try to determine the acuity of the finding or make any effort to contact the patient.

 

[RoyBasch]

I don't think me unilaterally deciding to enter charges in disregard to institutional politics is going to go over well. It's tempting to look into though. I don't even care about the billing, I'm just annoyed some frequently poorly mannered clown is collecting money for their valueless input with no real risk or responsibility.

Edit: That ACEP link is great, thanks for sharing.

Definitely agree. Once you bill, they cannot, so you are effectively "taking" their money (whether they deserve that/you are entitled to it or not). This is an issue at an institutional/administrative level. If you start unilaterally taking money from a specialty group that every hospital loves and treasures and generates lots of billing, YOU are going to have a problem real fast. If the ER group can get the cardiologists to surrender the billing of EKGs in the ER to the ER and the hospital admin signs off, so be it. But from their point of view, we have taken all the risk, made all the real time critical decisions, and this is easy almost "Free" money for them, so I doubt they'll let it go easy.

 

[DeadCactus]

Heh, everywhere I've worked they just call the ER and we have to deal with it entirely.
radiology does not try to determine the acuity of the finding or make any effort to contact the patient.

Fair enough, I've been spoiled. I'm still more content giving up billing to radiology given the complexity and risk. Cancer doesn't go undiagnosed because of some mild P wave abnormality that I missed because I don't have a $20k computer screen. I'd still fight for that being the choice of the emergency physician though.

 

[Birdstrike]

It’s your right to bill for the work you do.

If you found out that Plastic surgery was billing after the fact, for the lacerations you repaired, would you let them do it, “because it’s ‘free money’ for them and they ‘won’t let it go easily’”?

 

[emergentmd]

At the Hospitals ER, I ALWAYS Bill for EKG and X rays plain readings. Cards and Rads can do whatever they want after I bill.

In the FSER, I ALWAYS Bill for EKG and xrays plain readings. I have no cards/Rads to even care to bill MY Patients. That is what is great about FSERs. They all are MY pts and no one can tell me any different.

 

[Brigade4Radiant]

For RVU we always bill for the EKG so the CMG gets their money.

Cardiology reads them but I think it’s just a service they do for the hospital as their duty since they get paid salary.

 

[BoardingDoc]

Cards wanted to bill for EKGs at my shop as well, so it was brought it to the C-suite and simply said that if cards was willing to provide the same service we were, we would happily give them the billing.
That means that they need to provide real-time interpretations on all EKGs performed in the ED within 7 minutes of them being performed, 24/7. They said that wasn't feasible. We kept the billing.

 

[GeneralVeers]

It’s your right to bill for the work you do.

If you found out that Plastic surgery was billing after the fact, for the lacerations you repaired, would you let them do it, “because it’s ‘free money’ for them and they ‘won’t let it go easily’”?

Unfortunately the cardiology cartel has a tight grip on this at most hospitals. ED physicians are more of a nuisance than a necessity to the hospitals so we have little bargaining power on any issue.

 

[Birdstrike]

Unfortunately the cardiology cartel has a tight grip on this at most hospitals. ED physicians are more of a nuisance than a necessity to the hospitals so we have little bargaining power on any issue.

As one person, an Emergency Physician has virtually no bargaining power. Collectively, they have significant bargaining power. But they've got to agree on common goals, be willing to use their leverage, and have the fortitude to actually act on it through resistance.

I'm not saying that $8 EKG reads are necessarily a hill to die on. If you think it's worthwhile, fight for it, because it's in your best interest. If not, give it up willingly, because passing it up is in your best interest. Then, gladly let whoever wants it, take it. My suspicion is that this is the decision made in most places where the EPs concede the EKG reads to another department.