Cardiology Coding Alert

Question: The patient has an irregular heart rhythm that comes and goes. Based upon his symptoms, my cardiologist ordered a Holter monitor. In his office, the cardiologist attached the monitor to the patient and performed continuous recording for 24 hours. The cardiologist analyzed, compiled, and interpreted the electrocardiographic findings. When the test results came back, they showed that the patient definitely has paroxysmal atrial fibrillation. I’m not sure which CPT^® code to report on this claim. Can you help me?

Pennsylvania Subscriber

Answer: If the exam is performed in the cardiologist’s office, where the monitor is placed on the patient, recorded, removed, and interpreted by the physician or other qualified health care professional, then you should report global code 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional).

In your case, since the cardiologist performed both the professional and the technical components of Holter monitoring, including the review and interpretation and the connection, the scanning analysis and report, you should report 93224. Don’t forget to connect the diagnosis code I48.0 (Paroxysmal atrial fibrillation) to 93224 on your claim to show medical necessity for the testing.

Holter monitoring defined: With dynamic electrocardiography (ECG), also referred to as Holter monitoring, the cardiologist applies an ECG recorder to a patient for up to 48 hours to detect abnormal heart rates and rhythm. A Holter monitor continuously records the patient’s heart rhythm and helps your cardiologist figure out what’s going on with the patient’s heart by watching a longer period of responses the heart has over a period of time. Patients are typically also asked to keep a log of their activities with date/ time notations they make made while wearing it.