Cardiology Coding Alert

Question: I'm not sure how I should bill for a Holter monitor. Can you help me?

New York Subscriber

Answer: With dynamic electrocardiography (ECG), also referred to as Holter monitoring, the physician applies an ECG recorder to a patient for up to 48 hours to detect abnormal heart rates and rhythms. The physician then analyzes, compiles, and interprets the electrocardiographic findings.

Your choices for Holter monitoring include the following codes:

• 93224, External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation bya physician or other qualified health care professional
• 93225, ... recording (includes connection, recording, and disconnection)
• 93226, ... scanning analysis with report
• 93227, ... review and interpretation by a physician or other qualified health care professional.

Since 93224 is considered the global code for a Holter monitor, you would only report this code if the cardiologist performs all of the components of the procedure including the connection, the scanning analysis and report, and the physician's review and interpretation. You should not append modifier 26 (Professional component) to the service.

Reminder: For less than 12 hours of continuous recording, use modifier 52 (Reduced services), and for greater than 48 hours of monitoring, see Category III codes 0295T-0298T (External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage...)

You can report the separate components (93225-93227) of the service if your cardiologist only performs a specific part of the procedure. The hook-up (93225) and scanning of device (93227) component are most commonly performed in a hospital setting.

• 93225: For the connection of the device, you would report 93225.
• 93226: You would choose 93226 if the physician reports only the scanning analysis of portion of the test.
• 93227: For the physician's review and interpretation, opt for 93227.

Note: Some insurers may require coders to append modifier 59 (Distinct procedural service) to separate the component codes from 93224.