Cardiology Coding Alert

Question: If our cardiologist performs pacemaker and automatic implantable cardioverter/defibrillator (AICD) monitoring in her office (93731-93736 and 93741-93744), should I use modifier 26 on any of these codes? We don't own the equipment, but the company that does lets us use it as a "courtesy." We have our own pacer technician who does the test, and then our physicians read the results.

Tennessee Subscriber

Answer: Generally, you won't find any practice that owns the equipment. You should bill the total component if your technician performs the test. You'll choose the appropriate code by the type of system (single chamber, dual chamber, pacemaker, defibrillator, and with or without reprogramming). Here's a chart of your choices:

The modifier lowdown: If your practice provides the service's technical component (your personnel performs it in your office) and the professional component (the physician's interpretation of the report), you should report the appropriate code without any modifier.

If, however, a pacemaker/defibrillator company representative performs the device interrogation (which is sometimes the case), you should report only the service's professional component. You would do this by attaching modifier 26 (Professional component) to the appropriate CPT code.