Primary Care Coding Alert

Question: If a patient on a Holter monitor provides data for 7 days and 8 hours, do I round down to the nearest day and use 93241, or do the extra hours enable me to use 93245?

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Answer: The CPT^® general instructions for time-based coding, which tell you that “a unit of time is attained when the mid-point is passed,” do not apply to 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage …) or 93245 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage …). That’s because the wording in the code descriptors does not indicate a simple range (such as the office/outpatient evaluation and management [E/M] codes) or an “approximate” time (such as the preventive medicine individual counseling codes).

Instead, the wording for 93241 and 93245 tells you to apply the codes for “more than” a minimum time limit and “up to” a maximum time limit. From that, you can infer that the extra hours in your scenario lift you over the maximum threshold for 93241 and into the range for 93245, which is the code you should use in your encounter.