Cardiology Coding Alert

Learn why you won't report global codes very often.

You should focus on what technology your cardiologist uses for Holter monitor testing and the components he performs to choose between 12 codes that vary according to heart rhythm recording, storage, and analysis.

Sort Through Monitoring Groups

 To report Holter monitor testing, first home in on the correct four-CPT code series to use. Each group ��" 93224-93227, 93230-93233, and 93235-93237 (which each consist of a global code and two or three components) ��" describes a slightly different technique.

 Medicare divides devices into patient-activated recorders and non-patient-activated continuous recorders such as the Holter. The patient-activated recorder coding depends on whether the device has a "presymptom memory loop" and whether a technician and physician are on call to look at real-time results.

Non-patient-activated continuous recorders fall under these global codes:
• 93224 ��"  Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation
• 93230 ��" Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation.

Global patient-activated event markers go with this global code:
• 93235 ��"  Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and noncontinuous 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.

However, you may not be able to report these "package" codes very often. Instead, you'll need to break down each of these monitoring services into their components. You'll only report the one(s) that your practice provides.

93224-93227 = Visual Superimposition Scanning

The basics: You may most commonly report 93224-93227 for the monitoring services your cardiologist performs. Use one of these four codes to report services that specially trained technicians perform to visually scan patient waveforms generated by the monitor. The technicians compare these waveforms with a normal waveform to identify discrepancies.

By definition, "the device continuously reports electrocardiographic activity and [generally] stores data on a computer chip," says Christina Neighbors, MA, CPC, charge and reconciliation specialist at Franciscan Health System in Tacoma, Wash. Some use tape-based storage. Others use a memory card. "A permanent record of every activity is not always available," Neighbors says.

Within this set, 93224 is the global code, while each of the subsequent three codes describes separate slices of the overall service, such as 93225 (... recording [includes hook-up, recording, and disconnection]), 93226 (... scanning analysis with report) and 93227 (... physician review and interpretation). When your physician group provides all three of these services, you should report 93224.

In a nutshell: These three components represent the face-to-face work associated with the visit. Code 93225 represents hooking-up the device, providing patient instructions, and disconnecting the device. Code 93226 describes the retrieval of the device's data and generation of data summaries. Code 93227 includes the official interpretation of the data summaries.

Note: Most cardiology practices outsource the work represented by 93226 because they do not have the technology necessary to perform this part of the study, says Kelly Wojciechowski, CCA, coding and compliance specialist at Wheaton Franciscan Healthcare in Milwaukee.

With cardiac monitors, "the cardiologist will also ask patients to keep a diary and write down anything that happens," says Janet Gordon-Thatcher, senior book-keeper of patient accounts at Summit Cardiology Business Office in Seattle. "If they feel dizzy, what time was it? Did they have chest pain after they ate? The cardiologist also asks patients to keep it by their bed in case symptoms wake them. The diary helps to see if they feel anything when the monitor records an episode. Some people have no idea they are having a-fib when it is happening."

93230-93233 = Microprocessor Analysis

The second set of extended EKG monitoring codes, within the series 93230-93233, does not use superimposition scanning. Instead, a microprocessor analyzes the data and produces a printout of all recorded data in a miniaturized display.

Don't miss: Code 93230 describes the global service, while the other three codes represent specific pieces of that global service.

93235-93237 = Patient-Activated Event Markers

Your cardiologist may use a third recording mech-anism. Codes 93235-93237 are similar to the previous two sets in that they represent services in which a patient wears a long-term EKG monitor for 24 hours. The dif-ference is this recording is noncontinuous. For instance, the cardiologist can schedule a recording for certain time periods. Also, certain abnormal heart rhythms can trigger a recording.

You should report 93235 only if the physician performs all of the subscribed services. But if the cardiologist performs only one of these tasks, you'll report either 93236 (... monitoring and real-time data analysis with report) or 93237 (... physician review and interpretation).

Note: With this device, the monitor does the analysis and creates the report itself. This is why you won't have any "scanning analysis" code like the other two forms of Holter monitoring.