Cardiology Coding Alert

Only report 93268 if the cardiologist reports the entire cardiac event monitoring service.

In the past two issues of Cardiology Coding Alert, you have learned about the reporting rules regarding different types of cardiac monitoring, including Holter monitors and external mobile cardiovascular telemetry (MCT). Now, answer the following questions learn about a third type of cardiac monitoring — event monitors — and what you should know to submit clean claims in your cardiology office.

Grasp Definition of Cardiac Event Monitors

Question 1: What are cardiac event monitors?

Answer: Cardiac event monitors record segments of electrocardiogram (ECGs) activated by either the patient’s symptoms or by an internal automatic, pre-programmed detection algorithm - or both. The devices “then transmit the recorded electrocardiographic data when requested (but cannot transmit immediately based upon the patient or algorithmic activation rhythm),” according to the CPT^® guidelines.

CPT^® Assistant Vol. 21, No 10 offers even more explanation about these event recorders, “which are electrocardiographic rhythm-derived” by saying that they “include pre-symptom ‘memory loop technology’ for heart rhythm transmissions, which provide physicians with a rhythm strip of a patient’s cardiac rhythm ‘prior’ (presymptom), and/or ‘subsequent’ (postsymptom) to the symptoms that prompted the patient to activate the device.”

Delve Into Transmittal Process

Question 2: Can you explain more about how these recordings are transmitted?

Answer: CPT^® Assistant Vol. 21, No 10 offers very helpful insight into how cardiac event monitors transmit their data.

“Algorithm-determined automatic ECG-triggered, symptomatic patient-triggered events, or routinely scheduled rhythm recordings are transmitted to a remote attended surveillance center, which transmits recordings to the physician’s office during business hours where arrhythmia events meeting ‘immediate notification criteria’ are promptly brought to the interpreting physician’s attention,” according to CPT^® Assistant Vol. 21, No 10. After business hours, arrhythmia events meeting ‘immediate notification criteria’ are promptly brought to the on-call physician’s attention.”

Rely on This Code for Event Recording Global Service

Question 3: Which code should we report if the cardiologist performs the complete cardiac event monitoring service?

Answer: You should report global code 93268 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified health care professional), representing both the technical and professional parts of the service, if your cardiologist performs the complete cardiac event monitoring service.

Code 93268 includes the hookup, recording monitoring, receipt of transmission, disconnection, and the reviewing physician’s interpretation of the rhythm strips and a prepared report, per CPT® Assistant Vol. 21, No 10.

Turn to These Component Codes for Cardiac Event Monitoring

Question 4: What are the component codes for cardiac event monitoring?

Answer: Codes 93270-93272 represent the cardiac event monitoring component codes.

A common mistake people make with codes 93268-93272 is billing the global service when actually only the component services are provided, says Carol Hodge, CPC, CDEO, CCC, CEMC, certified medical coder at St. Joseph’s Cardiology in Savannah, Georgia.

If your cardiologist performs the connection, recording, and disconnection of the cardiac event monitoring, then you would report 93270 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)). “If the device and instructions were mailed to the patient and no instruction were given by the physician or staff, it is not appropriate to bill 93270,” Hodge explains.

On the other hand, if your cardiologist performs the transmission, download receipt, and the analysis, then you would report 93271 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis), per CPT^® Assistant Vol. 21, No 10.

Finally, if your cardiologist performs the professional component of the monitoring service only, the review and interpretation, then you would report 93272 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional).

Don’t miss: Since these component codes are included in 93268, you should never report 93270-93272 separately with 93268, Hodge says.

Mind the Monitoring Time

Question 5: How long does the monitoring for codes 93268-93272 have to last?

Answer: As per the code descriptors for 93268-93272, you can see that event monitors require 24-hour attended monitoring of the external device. If your cardiologist performs less than 24-hour attended monitoring, you should instead report 93799 (Unlisted cardiovascular service or procedure), per CPT^® Assistant Vol. 21, No 10.

“Code 93268 requires 24-hour attended monitoring of event recorder transmissions,” Hodge says. “This means that trained staff must be available around the clock to receive and respond to the transmission of an EKG recording if a patient has symptoms and activates the transmission of the EKG recording.” 

Don’t Separately Report Rhythm Strip Interpretation

Question 6: Can we separately report 93042 with codes 93268-93272?

Answer: No. The interpretation of all rhythm strips received during the 30-day period is included and should not be reported separately, Hodge says. This means you cannot additionally report 93042 (Rhythm ECG, 1-3 leads; interpretation and report only), according to CPT^® Assistant Vol. 21, No 10.

Mark Down Length of Reporting Period

Question 7: What is the reporting period for codes 93268-93272?

Answer: The reporting period for 93268-93272 is up to 30 days, as per these codes’ descriptors.

“It’s extremely important to create a coding policy for procedures that can only be reported once every 30 days to eliminate duplicate charge entry,” says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC’s Certified Cardiology Coder steering committee.