Cardiology Coding Alert

Question: The cardiologist took an electrocardiogram with the patient at rest after applying seven specialized alternans sensors to the patient in addition to seven conventional electrocardiogram electrodes to assess the risk of ventricular arrhythmia. After recording the baseline electrocardiograph, the cardiologist instructed the patient to exercise on a treadmill and gradually increased its speed to reach a heart rate between 90 and 110 beats per minute. The cardiologist then recorded another electrocardiogram of the patient at stress.

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Answer: You should report 93025 (Microvolt T-wave alternans for assessment of ventricular arrhythmias) for this procedure.

You’ll find further instruction for how to properly report 93025 from the National Correct Coding Initiative (NCCI) Policy Manual, National Coverage Determination (NCD) 20.30, and the Medicare Claims Processing Manual.

MTWA defined: “Microvolt T-wave Alternans (MTWA) testing is a non-invasive diagnostic test that detects minute electrical activity in a portion of the electrocardiogram (ECG) known as the T-wave,” NCD 20.30. “MTWA testing has a role in the stratification of patients who may be at risk for sudden cardiac death (SCD) from ventricular arrhythmias.”

Coverage: According to NCD 20.30, effective for claims with dates of service on and after March 21, 2006, Medicare will cover 93025 only for diagnostic testing for the evaluation of patients at risk of sudden cardiac death (SCD), when the cardiologist uses the spectral analysis (SA) method for calculating EKG voltage changes. 

“Effective for dates of service on and after January 21, 2015, Medicare Administrative Contractors (MACs) acting within their respective jurisdictions may determine coverage of MTWA diagnostic testing for the evaluation of patients at risk for SCD using all other methods,” according to NCD 20.30.

Modifier alert: You should apply modifier KX (Requirements specified in the medical policy have been met) to 93025 if the cardiologist performs the test using a method of analysis other than SA to evaluate a patient at risk for SCD from ventricular arrhythmias, and the cardiologist met all of the other NCD criteria , according to the Medicare Claims Processing Manual in Chapter 32, Section 370. You do not have to apply modifier KX on MTWA claims if the cardiologist used the SA analysis method.

Don’t miss: When a cardiologist performs a 93025 procedure, it requires a submaximal stress test that is different from a traditional exercise stress test (93015-93018), which uses a standard exercise protocol, according to the NCCI Policy Manual.

You should not separately report 93015-93018 “for the submaximal stress test integral to MTWA testing,” per the NCCI Policy Manual. Also, you should never report 93015-93018 on the same date of service as 93025.