Cardiology Coding Alert

Although all relevant codes describe 24-hour EKG monitoring, sometimes services may be provided for shorter or longer durations.
 
Shorter durations: If monitoring lasts less than 12 hours, you should not use the 12-hour, 30-day event monitoring codes. Instead, you should report an unlisted-procedure code (93799, Unlisted cardiovascular service or procedure) rather than appending modifier -52 (Reduced services) to the appropriate EKG monitoring code.
 
Many practices monitor their lines during business hours and instruct patients to go to the emergency department if they have events after office hours.
 
Longer durations: Payer policies vary far and wide when cardiologists use this technology to monitor patients over two or more consecutive days, such as
48-hour evaluations.
 
The best advice: "Call your carrier to see how they want it billed," says Sarah Tupper, CMC, coding specialist for Central New York Cardiology in Utica, N.Y.
 
Approach A: In some cases, cardiologists can report each test date separately.
 
Approach B: In others, insurers view long-term EKG monitoring as a complete service and do not allow you to report the global code twice - especially those adhering to frequency guidelines. Some of these guidelines dictate that a cardiologist can only order a Holter monitor for a patient once every six months.
 
Approach C: Many practices report the global code with modifier -22 (Unusual procedural services) and include two units of service to represent the 48-hour monitoring. Modifier -22 alerts insurers to the extra time and work on the monitoring procedure.
 
Approach D: Other coding professionals say that their payers require that they report the first date of service with the global code (such as 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) because the cardiologist performed both the technical and professional services.
 
Coders should report the services the physician provided on the second day with the professional component only (such as 93227), because they think that the cardiologist did not repeat the technical service, even though he may have.
 
Approach E: Some insurers may require coders to append modifier -59 (Distinct procedural service) in order to separate component codes 93226 (... scanning analysis with report) and 93227 from 93224.

Approach F: You may also find yourself using the unlisted-procedure code 93799. Like for less than 12-hour monitoring, CPT states, "Do not select a CPT code that merely approximates the service provided. If no such procedure or service exists, then report the service using the appropriate unlisted-procedure or -service code."