EM Coding Alert

From 93660’s descriptor, you can see that it includes continuous electrocardiogram (ECG) monitoring, intermittent blood pressure monitoring, and administration of medications, so you cannot report these services separately.

Modifier alert: Code 93660 splits into professional and technical components. If the physician does not own the tilt table equipment, you should append modifier 26 (Professional component). The facility that owns the equipment will report the technical component.

However, if the physician owns the tilt table, report 93660 without a modifier because this global code includes both the professional and technical components.

Don’t miss: If you’re unsure which codes have professional and technical components, refer to the Medicare Physician Fee Schedule (MPFS). Procedures that have professional components (modifier 26) and technical components (modifier TC, Technical component) will list separate fees for the professional component, the technical component, and the global service (professional and technical combined).

Tip 2: Understand Process of Tilt Table Test

Physicians use a tilt table test to evaluate patients when they experience symptoms of syncope (R55). Medical conditions that may cause syncope include vasovagal syndrome, arrhythmia, structural heart disease, heart attack, and cardiomyopathy ventricular dysfunction. Remember, if your cardiologist documents a definitive diagnosis, you should report the code for that diagnosis.

The test: In a tilt table test, the patient lies strapped to a special mechanized table, called a tilt table. The cardiologist slowly tilts the table slowly upward. This “tilt” simulates suddenly transitioning from a lying down position to a standing up position, helping to trigger the patient’s symptoms of syncope.

“The tilt table test (also called a passive head-up tilt test or head upright tilt test) records blood pressure and heart rate on a minute-by-minute basis while the table is tilted in a head-up position at different levels,” clarifies CPT^® Assistant Volume 22, Issue 11.

During a tilt table test, the cardiologist monitors the patient’s electrocardiogram (EKG) for any changes in heart rate and also monitors the patient’s blood pressure. The patient should let the cardiologist know if they experience any light-headedness or faintness during the test. If the patient does feel symptoms of syncope, the cardiologist will lay the table flat to help them regain consciousness. However, if the patient does not experience any signs or symptoms, the cardiologist may need to administer isoproterenol or perform mechanical manipulation of peripheral blood flow with a variety of compression devices to produce the symptoms of syncope.

“In the hospital setting, you would not report administration of isoproterenol separately,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services LLC in Centennial, Colorado.

Tip 3: Follow Rules for Billing E/M With Tilt Table Test

There are strict rules about when you can bill an evaluation and management (E/M) service with a tilt table test. In fact, you can only bill a separately payable E/M code on the same day that you report a tilt table test if your clinician’s documentation supports the separately identifiable service.

If the E/M service is unrelated to the tilt table test, is medically necessary, and your cardiologist appropriately documents it, then you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the code for the E/M service your cardiologist performed on the same date as the 93660 service.