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 ScanningThe 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 [...]