Cardiology Coding Alert

Question: How should we bill for postsymptom monitors? The new requirements indicate that a practice must have 24-hour attending. Our practice owns the equipment and reads the reports, but we do not have anyone attending 24 hours a day. Indiana Subscriber Answer: CPT codes 93012 (Telephonic transmission of postsymptom electrocardiogram rhythm strip[s], 24-hour attended monitoring, per 30-day period of time; tracing only) and 93268 (Patient demand single or multiple event recording with presymptom memory loop, 24-hour attended monitoring, per 30-day period of time; includes transmission, physician review and interpretation), which cardiac physicians use for electrocardiogram rhythm strip supervision, now include a 24-hour monitoring clause. Adding 24-hour monitoring to 93012 and 93268 should increase reimbursement for these codes, coding experts speculate. Even so, CMS states that you should not use the 24-hour, 30-day event monitoring codes unless attended monitoring was provided the entire time. Many practices monitor their lines during business hours and instruct patients to go to the emergency department if they have events after office hours. If your practice does not have 24-hour attended monitoring capability, you should report 93799 (Unlisted cardiovascular service or procedure) rather than appending modifier -52 (Reduced services) to 93012 and 93268 to show reduced service, CMS advises. You should also check your local Medicare and private insurance carrier guidelines before reporting codes for event monitoring. CMS also reports that the AMACPT editorial committee will be working on coding changes for unattended monitoring. Answers to Test Yourself and Reader Questions were provided by Martha Gerant, CPC, professional coder and reimbursement specialist for Cardiology Services in Olathe, Kan.; Sandy Fuller, CPC, a cardiology coding and reimbursement specialist in Abilene, Texas; and Jim Collins, CHCC, CPC, president of Compliant MD Inc. in Matthews, N.C., and compliance manager for Mid Carolina Cardiology in Charlotte, N.C.