Advanced Search

Cardiology Coding Alert

Deletion of G Code Should Prompt Call to Part B Carriers

Published on Fri Mar 01, 2002

Cardiologists who review data gathered by a non-looping event monitor and report G0016 (Post-symptom telephonic transmission of electrocardiogram rhythm strip[s] and 24-hour attended monitoring, per 30-day period: Physician review and interpretation only) should take note: HCPCS 2002 has deleted G0016 without providing further advice on how interpretation should be billed.
 
Ask your local Medicare Part B carriers whether they have responded to the change and, if so, how those interpretations should be billed.
 
These event monitors are more correctly called "post-symptom" because they do not record constantly and have no memory. Instead, the patient places electrodes on the wrists or fingers when experiencing rapid heartbeats and dials a number that "traces" the event. The cardiologist reviews and interprets the results. The patient may make several transmissions, says Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb.
 
Other codes describing non-looping event monitoring that remain in effect include G0015, 93012 and 93014.
 
All the codes (including G0016) have or had a 30-day period. Within that time, Rubio says, the appropriate code may be billed only once no matter how many transmissions were traced, analyzed and reviewed.
 
Note: If the cardiology practice leases but does not own the equipment, tracing (G0015) may not be billed to Medicare carriers.
 
The removal of G0016 complicates coding for these recorders, which until now was relatively straightforward. When a non-looping event recorder on a patient with private insurance was analyzed, 93012 and/or 93014 was used. For Medicare patients, cardiologists billed G0015 and/or G0016.
 
"With G0016 no longer available, the question becomes, how should the interpretation be reported," says Gay Boughton-Barnes, CPC, MPC, CCS-P, a cardiology coding and reimbursement specialist in Tulsa, Okla. "Are we just supposed to include the interpretation in the E/M visit when the cardiologist goes over the findings on the rhythm strip with the patient? Are we supposed to revert back to 93014, the equivalent CPT code? Is Medicare now saying that G0015 should be used to report the whole service, not just the tracing? We just don't know."
 
One local Medicare carrier is advising cardiologists to switch to the CPT code when only an interpretation is provided and to mix HCPCS and CPT codes if tracing and review are performed. Even so, many local medical review policies published before the current change instructed cardiologists never to mix CPT and HCPCS codes for the same service. Trailblazer Health Enterprises (Part B carrier in Texas) instructs cardiologists to report 93014 in place of G0016. If the cardiologist provides the complete service (i.e., tracing and review), G0015 and 93014 should be billed, according to Trailblazer's technical service desk.

Loop Memory Event Monitors

 
The cardiologist documenting services involving an event recorder may, in fact, be referring to a memory loop monitor. Loop monitors are considered "presymptom" recorders because they are always recording (typically using a one-minute memory loop) until the patient activates the device to memorize the current event.
 
Loop monitors were developed more recently than event recorders and are used more often; therefore, make sure that cardiologists document the correct type of event monitor using CPT terminology so the appropriate codes may be billed.
 
CPT lists four loop monitor codes (93268-93272), as does HCPCS (G0004-G0007).
 
Cahaba Government Benefits Administrators (Part B carrier in Georgia) and some other Medicare carriers use a CPT code to report one set of circumstances and a HCPCS code to report another.
 
For example, Georgia Medicare Policy 323 states that there must be the capacity "to receive and record transmissions 24 hours a day, every day of the year" to justify billing G0004-G0007. Furthermore, "transmissions must be received by a person capable of responding to the transmissions and not by an answering machine for review at a later time. The receiver of the transmission must be a technician, nurse or physician trained in electrocardiogram interpretation and abnormal rhythms."
 
Georgia Medicare also indicates that 93268-93272 should be used when the same type of device is used but less than 24-hour attended monitoring is provided.
 
Much the same as with the older post-symptom recorders discussed earlier, tracing may not be billed separately if the physician or clinic leases the equipment.
 
For example, if your carrier follows Georgia Medicare's coding guidelines, G0005 (hookup and recording) and G0007 (interpretation) but not G0006 (tracing) should be billed for round-the-clock monitoring using leased equipment.
 
For less than round-the-clock monitoring, only 93270 and 93272 should be billed.

Other Articles in this issue of

Cardiology Coding Alert

View All