Cardiology Coding Alert

Question: One of our payers considers real-time remote heart monitoring (MCOT) "investigational and not medically necessary." The payer's policy states that it will  deny 93228 and 93229. For 30 days of monitoring, may I instead use 93235 for each day?

Ohio Subscriber

Answer: You should not report 93235 (Wearable electrocardiographic rhythm derived 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) for the services you describe

The appropriate codes for real-time remote heart monitors, such as CardioNet's MCOT (Mobile Cardiac Outpatient Telemetry), are the "mobile cardiovascular telemetry" or "MCT" codes your payer's policy references: 93228-93229 (Wearable mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage [retrievable with query] with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days ...).

CPT states: "Cardiography" guidelines specify that for MCT (93228, 93229), "segments of the ECG data are automatically (without patient intervention) transmitted to a remote surveillance location by cellular or landline telephone signal." This description matches real-time remote heart monitors.

On the other hand, CPT's note following 93228-93229 specifies that 93235 is one of the codes you should look to "for wearable cardiovascular monitors that do not perform automatic ECG triggered transmission to an attended surveillance center."

Time matters, too: Save 93235 for Holter monitoring. A patient usually wears a Holter monitor for only 24 to 48 hours, and it records the entire time. Real-time remote heart monitors, on the other hand, provide extended periods of monitoring (up to 30 days) and automatically capture arrhythmias. The patient may activate transmission for symptomatic episodes, too.

Many practices find reporting a Holter code for each day of real-time remote monitoring tempting -- or forego using the technology altogether -- because the reimbursement for 93228 is so low. Medicare's national rate is roughly $25 for the 30- day service, which many practices find impractical for the amount of physician work and malpractice risk involved.

-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, CCC, CPC, ACS-CA, CHCC, president of CardiologyCoder.Com.