Cardiology Coding Alert

Hint: Knowing the length of monitoring time is crucial.

Sometimes your cardiologist may perform Holter monitoring by applying an electrocardiogram (ECG) recorder to a patient to detect abnormal heart rates and rhythm. When you file these types of claims, you must ensure that you know how long your cardiologist performed the Holter monitoring, as well as the components of the service they performed.

Read on to learn more.

Report These Codes for Holter Monitoring

Global code: If your cardiologist performs the Holter monitoring in their office, where they place the monitor on the patient, record the results, remove the monitor, and interpret the results, there is one choice — 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).

Your cardiologist must own the equipment to appropriately bill 93224. During the encounter, they will also instruct the patient on how to use the Holter monitor. You should use the date of the physician’s review as the date of service (DOS), according to A57476 “Billing and Coding: Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring.”

Component codes: If your 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
• 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

Don’t miss: 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.

Only submit codes 93224-93227 for up to 48 hours of continuous recording, per the CPT^® guidelines.

The DOS for 93255-93227 is the date your cardiologist performed the service, according to A57476.

“Be sure to review the documentation to verify what type of monitor was used for the patient,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “Most third-party monitor companies will supply the physician’s office with a weekly and monthly spreadsheet of all the monitors they have billed with the 93226 technical code. This will help you determine which monitor code to use as well, but confirmation is always the analysis time reported on the actual report.”

Don’t Forget Modifier 52

If you report 93224-93227 and your 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.

Focus on Options for Long-Term Continuous Recorders

In some cases, your cardiologist may perform Holter monitoring that lasts more than 48 hours and up to seven days or for greater than seven days up to 15 days. For those situations, you wouldn’t look to 93224-93227. Instead, you have an entirely different set of codes to choose from.

Report the following codes for recording that lasts more than 48 hours and up to seven days:

• 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). Remember: Code 93241 is the global code you should report if your cardiologist reports all of the parts of the service including the recording, scanning analysis with report, and the review and interpretation.
• 93242 (… recording (includes connection and initial recording)
• 93243 (… scanning analysis with report)
• 93244 (… review and interpretation)

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). Remember: Report 93245 for the global service if your cardiologist performs all of the parts of this service.
• 93246 (… recording (includes connection and initial recording))
• 93247 (… scanning analysis with report)
• 93248 (… review and interpretation)

Don’t miss: UnitedHealthcare defines the devices used with codes 93241-93248 as patch monitors, which record for longer periods.