Cardiology Coding Alert

Learn how to determine your date of service When you're deciding which CPT code series to use for 24-hour Holter monitor testing, you'll find that 93224-93227, 93230-93233 and 93235-93237 each describe a slightly different Holter monitor technique. 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, [...]