Cardiology Coding Alert

Question: How do we bill for a 48-hour Holter monitor?

Deena Wojtkowski
Milwaukee

Answer: Holter monitor codes (93224-93237) are for 24-hour monitoring. But if the patients symptoms are infrequent, the cardiologist may determine that the problem is more likely to be captured by the monitor if the patient wears it for 48 hours. In some cases, the monitor may stay on for 72 hours.

Some carriers will reimburse a 48-hour Holter monitor if the complete service code (for example, 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) is entered on the first line of the HCFA 1500 claim form, and 93237 (physician review and interpretation) is entered on the second line for the second 24-hour period. Do not bill 93235 twice because many services performed for the 24-hour Holter do not need to be reproduced for an additional 24 hours.

A paper claim should be sent to the carrier, says Linda Jackson, CCS, CPC, a Medicare consultant for Iowa Veterans Home in Marshalltown, Iowa, along with an attachment of medical necessity that explains why 48-hour Holter monitoring was needed.

Local Medicare carrier policies regarding 48-hour Holter monitors can vary and also may differ substantially from those of commercial payers. In addition, many carriers simply will not pay for anything other than one 24-hour Holter monitor, so you should contact the carrier in question to determine how it wants you to bill for this service.