Cardiology Coding Alert

If the physician owns the tilt table, report 93660 without a modifier.

You read in the medical documentation that the cardiologist performed a tilt table test to evaluate a patient who has been experiencing symptoms of syncope (R55) — the loss of consciousness and posture more commonly known as recurrent fainting or passing out.

Read on to learn everything you need to know about how to submit clean tilt table claims in your cardiology practice.

Rely on 93660 for Cardiovascular Tilt Table Testing

When the cardiologist performs a tilt table test, you should report 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention).

In a tilt table test, the patient lies strapped to a table while the table slowly tilts upward. This “tilt” simulates transitioning from a lying down position to a standing up position, helping to trigger the patient’s symptoms.

During a tilt table test, the cardiologist monitors the patient’s blood pressure and heart rate for any changes that might occur. The cardiologist may need to administer isoproterenol or mechanical manipulation of peripheral blood flow with a variety of compression devices to produce the symptoms of syncope.

Global 93660 Code Includes Both Professional and Technical Components

Code 93660 splits into professional and technical components. If the physician does not own the tilt table equipment, you should append modifier 26 (Professional component). The facility that owns the equipment will report the technical component.

But if the physician owns the tilt table, then you should report 93660 without a modifier because this global code includes both the professional and technical components.

If you’re ever unsure about which codes have professional and technical components, refer to the Medicare Physician Fee Schedule (MPFS). Procedures that have professional components (modifier 26) and technical components (modifier TC, Technical component) will list separate fees for the professional component, the technical component, and the global service (professional and technical combined).

Report E/M and Tilt Table Test With Caution

You cannot bill a separately payable evaluation and management (E/M) code on the same day that you report a tilt test unless your physician’s documentation supports this separately identifiable service. If the documentation does support the separately identifiable service, then you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the code for the E/M service that the physician performed on the same date as the 93660 service.

Caution: Code 93660 has a global period indicator of 000 on the MPFS. That 000 indicator means: “Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable.”

So, before you report an E/M with modifier 25 on the same date as the tilt table test, you should be sure to confirm that documentation shows the E/M is separately identifiable from the work usually required for 93660.

BP Finger Cuff and Urgent/Emergent Cardioversion Included in 93660

Although the physician may use a finger blood pressure (BP) cuff during the patient’s tilt table test, the BP monitoring is considered part of the larger tilt table test, and you should not report it separately.

Rationale: If you look at the code descriptor for 93660, you will see that it includes “intermittent blood pressure monitoring,” but does not specify the method. with or without pharmacological intervention). Although a finger BP cuff may provide continuous monitoring, you still should not report the monitoring using a separate code.

Don’t miss: Additionally, if an urgent/emergent cardioversion is required, it is not appropriate to report 92960 (Cardioversion, elective, electrical conversion of arrhythmia; external) along with 93660, according to 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. You should report 92960 when an elective external electrical conversion of arrhythmia is provided, this means the cardioversion must be a scheduled/planned procedure.