Primary Care Coding Alert

Question: How should I bill for a Holter monitor if the device is not left in place for the full 24 hours? A patient removed it before the full time was up.

Nevada Subscriber

Answer: A Holter monitor is a portable device that consists of an electrocardiograph (ECG) and a recording system capable of storing up to 24 hours of an individual's ECG record. The codes for such ECG monitoring are in the series 93224-93237.

As with other ECG codes (e.g., 93000-93010), there are codes for providing the global service and codes for providing the individual components if you do not provide the global service.

If you bill the global service (e.g., 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), the individual components (such as hookup and reading) are included.

If the patient does not leave the Holter monitor in place for 24 hours, and that precludes you from providing the global service, you may still be able to code the components that you did provide. At a minimum, you may be able to code the applicable recording code (93225, ... recording [includes hookup, recording, and disconnection]) because the practice performed the hookup, recording and disconnection even though the patient removed the monitor prematurely.

Answered by Kent Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.