Cardiology Coding Alert

 4 expert tips help you realize long-term EKG reimbursement To code 24- or 48-hour Holter monitors accurately, you should know whether the devices are patient-activated or are nonpatient-activated continuous recorders.
 
Now that CMS has unveiled a new framework for ambulatory electrocardiography (AECG) or Holter monitor codes, it's even more important that you get your codes right. These four pointers will help. Tip 1: Take Note of CMS' Memo on Carrier Decision-Making Ambulatory echocardiographic monitoring cost Medicare $22.7 million in 2001, so it's no wonder that CMS wants to keep tabs on these services. 
 
AECG or Holter monitors record patients during their daily activities (including sleep) and document symptoms of cardiac arrhythmias. An Aug. 26 coverage memo from CMS laid down a framework for carriers to decide whether and how to cover these devices, which patients often wear for up to 24 hours in an outpatient setting.
 
CMS didn't decide which devices to cover or give the carriers specific instructions. Instead, the agency provides carriers with a framework to divide the devices into categories.
 
CMS spells it out: CMS' framework divides devices into patient-activated recorders and nonpatient-activated continuous recorders such as the Holter. Patient-activated recorders are divided depending on whether they have a "presymptom memory loop" and whether there's a technician and physician on call to look at the results in real time.
 
"I've noticed that larger insurance companies have adopted the federal regulations on most of these procedures," says Angelina Hamilton, LPN, CPC, lead coder for Lake Regional Medical Management in Osage Beach, Mo. So knowing a little more about how they determine coverage can help you in the long run. Tip 2: Know Your Long-Term EKG Technology
 
When reporting Holter monitor testing, your first dilemma is choosing the correct CPT code series to use. You'll find that 93224-93227, 93230-93233, and 93235-93237 each describe a slightly different Holter monitor technique.
 
You will need to know what technology you have, because these codes vary from each other according to heart rhythm recording, storage, and analysis: Nonpatient-Activated Continuous Recorders:
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. Patient-Activated Event Markers:
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. The new CMS framework suggests [...]