Cardiology Coding Alert

Code 93228 is the professional component.

External mobile cardiovascular telemetry (MCT) is a type of cardiovascular monitoring where your cardiologist uses in-person and remote technology to assess patients’ cardiovascular rhythm data. If you don’t pay special attention to the documentation, such as making sure you only report the MCT codes once per 30 days, your claims could be in jeopardy of denial.

Read on to learn more.

Step 1: Delve Into Mechanics of MCT Devices

MCT devices continuously record the electrocardiographic (ECG) rhythm of the patient’s heart via external electrodes that the physician places on their body, per the CPT^® guidelines. MCTs 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.

How it works: With MCTs, segments of the ECG data are automatically transmitted to a remote surveillance location via either a cellular or landline telephone signal, per the guidelines.

“The segments of the rhythm, selected for transmission, are triggered automatically (MCT device algorithm) by rapid and slow heart rates or by the patient during a symptomatic episode,” according to the CPT^® guidelines. “There is continuous real-time data analysis by preprogrammed algorithms in the device and attended surveillance of the transmitted rhythm segments by a surveillance center technician to evaluate any arrhythmias and to determine signal quality. The surveillance center technician reviews the data and notifies the physician or other qualified health care professional depending on the prescribed criteria.”

“MCT is often prescribed for patients with rare or intermittent episodes of arrhythmia or those who are asymptomatic,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “The extended wear time captures an arrhythmia that may not occur during the shortened wear time of a Holter monitor and is also helpful in identifying a silent pattern of irregular cardiac activity.”

Step 2: Report Physician’s Analysis of Data With This Code

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) represents the professional component of mobile MCT service only. “The physician analysis of the data is reported with code 93228,” explains CPT^® Assistant Vol. 21, No. 10.

Note, that per the code descriptor, 93228 includes the 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.

Tip 1: Per CPT^®, report 93228 only once per 30 days, no matter how many transmissions the physician receives on a particular patient during that period.

Tip 2: Never report 93228 in conjunction with external electrocardiographic recording codes 93224 or 93227, according to CPT^®.

Step 3: Focus on 93229 for Technical Component

Report the technical component of the MCT service with 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).

Code 93229 represents the technical support the attended surveillance center provides in conjunction with the MCT. “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,” according to CPT^® Assistant.