Maximize Reimbursement For Cardiac Event Monitors
Published on Sat Jan 01, 2000
Event monitors often are used by cardiologists to track a patients heart condition. Billing for this service has been confusing because CPT lacked specific codes and Medicare and private payers have differing coding requirements. By using new codes included in CPT 2000 and drawing clear lines between Medicare and other payers, cardiologists can ensure proper reimbursement when providing monitoring services.
Until recently, there were no codes for implantable loop recorders (ILR), and cardiologists often were confused about using the unlisted code (33999) for these devices. But CPT 2000 includes three new codes for this type of event monitor that will facilitate billing for it.
The three new implantable loop codes are:
33282implantation of patient-activated cardiac event recorder
33284removal of an implantable, patient-activated cardiac event recorder
93727electronic analysis of implantable loop recorder (ILR) system (includes retrieval of recorded and stored ECG data, physician review and interpretation of retrieved ECG data and reprogramming).
The loop recorder is implanted subcutaneously in the left pectoral region and must be removed when it is no longer clinically necessary or when its battery runs out, which happens after approximately 14 months. To date, the only such device with FDA approval is the Medtronic Reveal ILR, says Sueanne Bicknell, RRA, CPC, CCS-P, compliance administrator for CPR-Heart Place, a group practice with 65 cardiologists in Dallas.
The recorder is placed under the skin, similar to a pacemaker, and remains there. Implanting the recorder is an outpatient procedure; typically, the patient will return two weeks later so the cardiologist can test the device in his or her office.
Coding and billing points cardiologists should note regarding ILRs include:
1. Medicare limits the use of these devices to one diagnosissyncope (780.2).
2. The 93727 code includes not only reprogramming but also any subsequent evaluation.
3. There are not time limits on billing for return visits to the doctor after the ILR is implanted, as is the case with some other event monitors that restrict cardiologists to billing only once every 30 days. When the device is implanted, however, the first 90 days that follow are part of that procedures global period.
4. Any electrophysiological testing performed before the ILR is implanted should be coded and paid separately.
5. No surgery assist is allowed to be billed for implant or removal.
6. Removing an ILR on the same day you put in a pacemaker implant is inclusive and will not be paid separately.
7. Medicare will pay for only one ILR every two years.
8. Any evaluation and management (E/M) visits on the same day as a 93727 to test the device must be billed with modifier -25 (significant separately identifiable evaluation and management service by the same physician on [...]
