Cardiology Coding Alert

The date of service differs for component versus global codes.

When a cardiologist performs a Holter monitoring service, the coding can be tricky because you must pay attention to so many important details such as what components they did, if they own the equipment or not, and how long the monitoring went on for. If you miss any of these critical details, you could risk denials.

Take a look at this primer to assist you with reporting clean Holter monitoring claims in your office.

Look to 93224 for Global Holter Monitoring

When the cardiologist performs the Holter monitoring in their office, as well as where they place the monitor on the patient, record the results, remove the monitor, and interpret the results, report the global code 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional).

Here are some handy tips to follow when reporting 93224:

• Tip 1: The cardiologist must own the equipment.
• Tip 2: Use either the date of the hookup for the date of service (DOS) or the date of the physician review. Remember: “Nationally, for physician practices, the standard has been for the global component, to pick either the date of the hookup for the date of service OR the date of the physician review and stick with that date consistently,” Robin Peterson CPC, CPMA, senior consultant; compliance review, education, and training, Pinnacle Enterprise Risk Consulting Services in Centennial, Colorado. “Check with your specific Medicare administrative contractor (MAC) for reporting guidance.”
• Tip 3: The cardiologist will also instruct the patient on how to use the Holter monitor during a 93224 encounter.
• Tip 4: Code 93224 represents both the technical and professional components of the service, so do not append modifiers 26 (Professional component) or TC (Technical component) to this code.

“Owning the equipment has become so expensive for physician practices that most of the time the equipment is supplied by an outside source,” according to Peterson. “Be sure to verify ownership of the equipment before deciding on the correct Holter monitor code(s) to bill.”

Report Component Codes Under These Circumstances

If the cardiologist performs Holter monitoring but only performs a specific portion of the procedure instead of the global service (93224), consider the following three component codes:

• 93225 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)) for the connection of the device only.
• 93226 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report) for the scanning analysis portion only.
• 93227 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional) for the physician’s review and interpretation only.

Here are some handy tips to follow when reporting component codes 93225-93227:

• Tip 1: Since component codes 93225-93227 are included in global code 93224, never report these codes in conjunction with each other, according to CPT® Assistant Vol. 21, No. 10.
• Tip 2: The DOS for 93255-93227 is the date your cardiologist performed the service, according to A57476.

Remember Modifier 52 in Some Cases

If you report 93224-93227 and the cardiologist performs less than 12 hours of continuous recording, you should append a modifier to the appropriate Holter monitor codes. The correct modifier in this scenario is modifier 52 (Reduced services), per CPT^® Assistant.

For example, the cardiologist attaches a Holter monitor to a patient for eight hours of continuous recording to detect abnormal heart rates and rhythms. The cardiologist performs all of the components of the service, including the connection, the scanning analysis and report, and the review and interpretation of the results. Report 93224-52 on your claim since the cardiologist only performed eight hours of continuous recording.

Recording Timeframe Longer Than 48 Hours? Do This

You can only submit 93224-93227 for up to 48 hours of continuous recording. However, when your cardiologist performs Holter monitoring lasting more than 48 hours and up to seven days or for greater than seven days up to 15 days, you have an entirely different set of codes to look to, which include:

• 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation). Code 93241 describes the complete service, and you should report it if your cardiologist performs all of the parts of the service, including the recording, scanning analysis with the report, and the review and interpretation of results.
• 93242 (… recording (includes connection and initial recording). Report for ECG initial connection and recording only.
• 93243 (… scanning analysis with report). Report for scanning analysis and report only.
• 93244 (… review and interpretation). Report for the review and interpretation of the recording only.

On the other hand, for recording that lasts more than seven and up to 15 days, look to the following codes:

• 93245 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation). Code 93245 is a complete procedure. Report for the global service if the cardiologist performs all of the parts of this service, including the ECG recording, scanning analysis with report, and review and interpretation of the results.
• 93246 (… recording (includes connection and initial recording)). Report for initial connection and recording only.
• 93247 (… scanning analysis with report). Report for the scanning analysis and report only.
• 93248 (… review and interpretation). Report for the review and interpretation of the recording only.