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Internal Medicine Coding Alert

Reader Questions:

Dont Double-Bill 93235 for 48-Hour Monitoring

Published on Tue Jul 01, 2003

Question: Our internist ordered and interpreted data from a 24-hour Holter monitor. Is the correct code 93224-26? Also, how should we bill for 48-hour monitoring?

South Carolina Subscriber
 


Answer: You should not append modifier -26 (Professional component) to 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). CPT lists a separate code for this service, 93227 (... physician review and interpretation).
 
You should report 93224 if the physician performs all of the described services, including hooking up and removing the monitor, analyzing the scan, and reviewing and interpreting the results. If the internist performs only some of these tasks, you should bill for the individual services only. If the internist reviews and interprets the data but does not own the equipment and does not perform any other services, you should report 93227.
 
Holter monitor codes (93224-93237) are for 24-hour monitoring. Some carriers will reimburse a 48-hour Holter monitor if you enter the complete service code on the first line of the CMS-1500 claim form, such as 93235 (Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous 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). You should enter 93237 ( physician review and interpretation) on the second line for the second 24-hour period. Do not bill 93235 twice because many services performed for the 24-hour Holter do not need to be reproduced for an additional 24-hours.
 
To be safe, you should send a paper claim to the carrier along with an attachment explaining the medical necessity for 48-hour monitoring. Local policies vary, and some carriers will not pay for Holter monitoring longer than 24 hours, so you need to ask your carrier first.

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