Cardiology Coding Alert

Key: You will need to know what technology your cardiologist uses because these codes vary from each other according to heart rhythm recording, storage and analysis.

93224-93227 = Visual Superimposition Scanning

The basics: You will 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.

"The device continuously reports electrocardiographic activity and stores data on a computer chip," says Christina Neighbors, MA, CPC, charge and reconciliation specialist at Franciscan Health System in Tacoma, Wash. "A permanent record of every activity is not always available."

Within this set, 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) 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).

In a nutshell: These three components represent the face-to-face work associated with the visit (hook-up of the device, providing patient instructions, and disconnection of the device--93225), the retrieval of the device's data and generation of data summaries (93226), and the official interpretation of the data summaries (93227).

When your physician group provides all three of these services, you should report 93224. 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.

With cardiac monitors, "the cardiologist will also ask patients to keep a diary and write down anything that happens," says Janet Gordon-Thatcher, senior bookkeeper of patient accounts at Summit Cardiology Business Office in Seattle, Wash. "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.

Again, 93230 (Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning ...) 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 mechanism. 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 difference 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'll report this type of monitoring with global code 93235 (Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and noncontinuous recording, and real-time data analysis ...).

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).

Research Carrier Preference for Date of Service

Many coders express confusion about what day to report the Holter. Does the date depend on when the cardiologist applied the device (initiated date) or when the cardiologist interpreted the results (completion date)? Unfortunately, the answer is--it depends.

Option 1: "Bill for the date of hookup, not the interpretation," Gordon-Thatcher says. You can usually report the Holter code this way, like other diagnostic test interpretations, but usually does not mean always.

For example: Empire Medical Services for New York and New Jersey states in its local coverage determination that "the date of the service is the date of the hookup."

Option 2: Other carriers maintain that the technical component of the hookup would be one date and the date of the physician's interpretation would be at the end of the monitoring period, so you should report that date instead.

For example: If the patient goes to a hospital for the Holter monitor connection, you may report one aspect of the code series (93224-93227)--such as the physician review and interpretation (93227)--on the date the hospital disconnects and downloads the monitor.

Best bet: See what your carrier prefers ahead of time.

Save time: Make sure you capture all charges for the patient on one fee slip. "My doctors are notorious for forgetting to circle the Holter CPT code, so oftentimes when I get the Holter slip in from the tech, the other charges have already been posted, and it gets really tedious doing the backtracking and cleanup work. Train everyone the way you want it done early," Gordon-Thatcher says.