Cardiology Coding Alert

Question: How should we bill for 48- or 72-hour Holter monitors? Pennsylvania Subscriber Answer: Typically, Holter monitors are used for 24 hours, and the four CPT codes that describe this service refer specifically to the 24-hour time frame: 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 93225 recording (includes hook-up, recording, and disconnection) 93226 scanning analysis with report 93227 physician review and interpretation. Occasionally, the cardiologist may want the patient to wear the Holter monitor for 48 or even 72 hours. In such cases, modifier -22 (Unusual procedural services) should be used to obtain additional reimbursement for the extra work and time required for a 48- or 72-hour Holter. Note: Claims with modifier -22 should include a letter detailing how much additional work was performed and why it was required. Some coding experts have suggested that because 93224 is a comprehensive code that includes all the components described in the three codes that follow, you should bill 93224 for the first 24 hours, and 93226 plus 93227 for any subsequent 24 hours because these do not include hook-up or disconnection. Others have suggested that 93224 be billed in units, with each unit corresponding to a 24-hour period.

Some carriers may permit such billing for 48- and 72-hour Holter monitors, but others may follow frequency guidelines, which dictate that a Holter monitor use be covered only once every six months. And if more than one Holter is permitted, the carrier may require that modifier -59 (Distinct procedural service) be appended so that the component codes (93226 and 93227) are not bundled with 93224.

Because coverage and reimbursement for these services are carrier-specific, you should ask your individual payers for their policies on this issue.