Cardiology Coding Alert

Question: When I report a comprehensive electrophysiology study and tilt table test on the same day, do I need to append modifier 59?

Idaho Subscriber

Answer: You should not need to append modifier 59 (Distinct procedural service) because Correct Coding Initiative (CCI) edits do not bundle 93620-+93622 (Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia ...) with 93660 (Evaluation of cardiovascular function with tilt-table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention).

Watch out: Some payers require prior authorization for tilt-table testing or have very specific coverage criteria. For example, Blue Cross of Idaho's medical policy indicates tilttable testing to diagnose syncope is investigational, but the test "may be considered medically necessary for the classification of neurogenic syncope in patients who are being considered for pacemaker treatment" (www.bcidaho.com/providers/medical_policies/med/mp_20109.asp).

Many payers will cover 93660 only when paired with 780.2 (Syncope and collapse). But you'll need to be able to back up the code with specific indications. For example, Cigna's coverage policy states tilt-table testing is medically necessary for either of the following:

• "evaluation of syncope in an individual with or without structural heart disease, when the cause of syncope has not been established following a complete history and physical examination and appropriate diagnostic testing, including a twelve-lead electrocardiogram (ECG), echocardiogram, and formal exercise tolerance testing"
• "evaluation of an individual in whom the apparent cause of syncope, such as asystole or high-degree atrioventricular (AV) block, has already been established, but results of tilt table testing are needed to determine the treatment plan."

Cigna lists several other non-covered indications, such as a "single syncopal episode, when clinical features support a diagnosis of vasovagal syncope" (www.cigna.com/customer_care/healthcare_professional/coverage_positions/medical/mm_0066_coveragepositioncriteria_tilttable_testing.pdf).