Cardiology Coding Alert

Question: May I append modifier 26 to 93660 if the test was performed outside of our office?

Colorado Subscriber

Answer: Yes. Code 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention) splits into professional and technical components. If you're reporting only the physician's services, as in your case, you should append modifier 26 (Professional component).

If you're ever unsure about which codes have professional and technical components, refer to the Medicare Physician Fee Schedule. Procedures that have professional components (modifier 26) and technical components (modifier TC, Technical component) will list separate fees for the professional component, the technical component, and the global service (professional and technical combined).

Diagnosis: Many payers require 780.2 (Syncope and collapse) to support medical necessity for 93660. Under ICD-10, you would instead report R55 (Syncope and collapse).