Cardiology Coding Alert

Remember: Report mobile cardiac telemetry monitor codes 93228 and 93229 only once per 30 days.

Your cardiologist may use different types of cardiac monitoring, including external mobile cardiovascular telemetry (MCT), to evaluate patients. Navigating these external MCT claims can be tricky because you must follow numerous guidelines and rules. But, you don’t have to let these services trip you up.

Read on to make sure your MCT claims are always up to par.

Editor’s note: Tune in to the next issue of Cardiology Coding Alert to learn even more about the different types of cardiac monitoring you may see in your cardiologist’s medical documentation.

First, Define MCT For Clarity

MCT devices continuously record a patient’s heart rhythm by using external electrodes the physician places on the patient’s body, per the CPT^® guidelines.

“Mobile cardiac telemetry monitors (93228, 93229) have the capability of transmitting a tracing at any time, always have internal ECG analysis algorithms designed to detect major arrhythmias, and transmit to an attended surveillance center,” according to the CPT^® guidelines.

Report 93228 For MCT Professional Component

Code 93228 (External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional) is the professional component of mobile MCT and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring, according to Mary I. Falbo, MBA, CPC, CEO of Millennium Healthcare Consulting Inc. in Lansdale, Pennsylvania.

Don’t miss: “Code 93228, which describes the physician’s review and interpretation along with a report of the events transmitted for physician review during a 30-day time frame, is reported only once per 30 days regardless of the number of transmissions the physician may receive on that particular patient during that period,” reiterates CPT^® Assistant Vol. 21, No. 10.

Turn to 93229 for Technical Component of MCT

Code 93229 (External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional) is the technical component of MCT, says Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, CPEDC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador and director of revenue operations at Boston Children’s Hospital in Boston, Massachusetts.

According to Falbo, 93229 includes all of the following elements within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:

• Patient hook-up and patient-specific instruction and education
• Transmission and receipt of ECG
• Analysis of ECG by nonphysician personnel
• Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
• Equipment maintenance
• All supplies necessary for completion of the monitoring

Bottom line: MCT mandates attended surveillance by a remote monitoring center, according to CPT^® Assistant Vol. 21, No. 10. This attended surveillance “requires immediate availability of a technician to respond to the rhythm or device alert transmissions from the patient as they are generated and transmitted to the surveillance location.” The surveillance center should report their services with 93229.

Mind These MCT Documentation Requirements

The following documentation requirements apply to all claims for 93228 and/or 93229, according to Falbo:

• The date of service (DOS) must be reported as the date the patient was initially placed on the monitor.
• A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
• Any additional claims reporting codes 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.