CMS Electrocardiograms Form

Summary Of Evidence

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Analysis of Evidence

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The electrocardiogram (ECG, EKG) and ECG rhythm strip records the electrical activity of the heart throughout the cardiac cycle of contraction (depolarization) and relaxation (repolarization). The changes in electrical potential during the cardiac cycle are detected at the body surface and recorded on graph paper. The recording is reviewed by a physician who provides an interpretation and written report. An ECG may be reported as the technical aspect only, the interpretation and written report only, or both aspects together as one service.

The electrical activity of the heart can be viewed along various electrical axes (viewpoints). Each viewpoint is described as a "lead”. A typical ECG views the heart from 12 axes and, therefore, has 12 leads. A rhythm strip typically includes one to three leads. Typically, a 12-lead ECG is a separate document from the medical progress notes, while a printed rhythm strip may be pasted into the progress notes.

An ECG is indicated to diagnose or treat a patient for symptoms, signs, or a history of heart disease; or systemic conditions that affect the heart, including:

• Chest pain or angina pectoris,
• Myocardial ischemia or infarction,
• Arteriovascular disease including coronary, central, and peripheral disease,
• Hypertension,
• Conduction abnormalities,
• Cardiac rhythm disturbances,
• Cardiac hypertrophy,
• Heart failure,
• Pericarditis,
• Structural cardiac conditions,
• Endocrine abnormalities,
• Neurological disorders affecting the heart,
• Syncope,
• Paroxysmal weakness,
• Palpitations,
• Sudden lightheadedness,
• Electrolyte imbalance,
• Acid-base disorders,
• Temperature disorders,
• Pulmonary disorders, and
• Drug cardiotoxicity.

An ECG may help identify cardiac disorders as part of a preoperative clinical evaluation. A preoperative ECG may be reasonable and necessary under one of the following conditions:

• In the presence of pre-existing heart disease such as congestive heart failure, prior myocardial infarction (MI), angina, coronary artery disease, or dysrhythmias;
• In the presence of known comorbid conditions that may affect the heart, such as chronic pulmonary disease, peripheral vascular disease, diabetes, or renal impairment; or
• When the pending surgery requires a general or regional anesthetic.