Cardiology Coding Alert

Learn to report only the services your cardiologist actually performed

When you're preparing to report cardiac monitoring, you need to keep one important thing in mind: You must differentiate cardiac monitoring technologies in order to ascertain which set of codes you should use.

Which codes you'll report depends on three kinds of technologies: visual superimposition scanning, microprocessor analysis, and patient-activated event markers.

93224-93227 = Visual Superimposition Scanning

You will most commonly report 93224-93227 for the monitoring services your cardiologist performs. Within this set, 93224 (Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation) is the global code, while each of the subsequent three codes describes separate slices of the overall service, such as, 93225 (... recording [includes hook-up, recording, and disconnection]), 93226 (... scanning analysis with report), and 93227 (... physician review and interpretation).

Use these four codes to report services that specially trained technicians perform to visually scan patient waveforms generated by the monitor. The waveforms are then compared with a normal waveform to identify discrepancies.

Here's another key to success - you should only report the services your cardiologist actually provided. If your cardiologist performed all of the described services, which include hooking up and removing the monitor, analyzing the scan, and reviewing and interpreting the results, you should report the first code in the series (such as, 93224).

You should use this code because it encompasses all of the procedure's components, says Lisa Center, CPC, quality review coordinator for Freeman Health System in Joplin, Mo.
 
If the cardiologist performed only some of those services, however, you will bill only for the individual services provided.

Note: All three of the extended monitoring tech-nologies break out the individual components separately.

Example: Your office monitored a patient using the equipment described in 93224, but the cardiologist did not do the scanning analysis. You may have an outside company perform that technical component.

In that scenario, you would report 93225 for the recording, hook-up and removal of the cardiac monitor and 93227 for physician review and interpretation. The scanning company would report codes of its own for the analysis.

Heads up: Even if your office is limited to another type of technology, you may find yourself reporting codes from this series when the cardiologist provides the patient with a cardiac device monitor in the hospital.

For example, if your cardiologist interprets information from a visual superimposition scanning cardiac device in the hospital, you'll report his interpretation using 93227, says Kathy Beckette, medical biller at Cardiac Associates of New Hampshire in Concord, N.H.

93230-93233 = Microprocessor Analysis

The second set of extended EKG monitoring codes within the series 93230-93233 does not use superimposition scanning. Instead, a microprocessor analyzes the data and produces a printout of all recorded data in a miniaturized display.

Again, 93230 (Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation) describes the global service, while the other three codes represent specific pieces of that global service.

Example: "We report 93230 when the cardiologist places this type of cardiac monitoring device on a patient in our office," Becket says. That represents the global service.

"When the patient has had the same device put on in another office, then we use 93232-93233," Becket adds. "That way we can receive reimbursement for the scanning and interpretation."

93235-93237 = Patient-Activated Event Markers

Your cardiologist may use a third recording mechanism. Codes 93235-93237 are similar to the previous two sets in that they represent services in which a patient wears a long-term EKG monitor for 24 hours.
 
These studies are unique because they require patients to indicate when they experience symptoms. "Hitting the 'record' button will pinpoint certain areas," and technicians then pay closer attention to the time frame noted when the recording is returned to the office, Beckett says.

You'll report this type of monitoring with global code 93235 (Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient-activated; includes monitoring and real-time data analysis with report, physician review and interpretation).
 
If your cardiologist performed only a part of this global service, you'll report either 93236 (...monitoring and real-time data analysis with report) or 93237 (...physician review and interpretation).

Red flag: If you're not sure what code describes your practice's machine, ask your cardiologist or technicians what type of monitor he used. You can also check with the company providing the equipment to determine what code criteria your documentation meets.

Note: See "Clip and Save: Don't Lose Heart Trying to Differentiate CPT's Cardiac Monitoring Series" featured in the following article.