Primary Care Coding Alert

Question: Which modifiers should I use for an encounter where our physician provided an interpretation and report for an electrocardiogram (EKG) and Holter monitor on the same day? Will 93224-26, 93000-26-59 work?

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Answer: Coding for both of these services on the same day is the easy part here, and you are using modifier 59 (Distinct professional service) correctly.

What’s not so easy is coding for the professional component of these tests — the interpretation and report you mention. That’s because the codes you reference include both the technical and professional components of the service, while your physician provided only the professional component (i.e. the interpretation and report) in each case.

So, you cannot add modifier 26 (Professional component), or modifier TC (Technical component) for that matter, to either 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) or 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 fact, there are separate codes for both services if the provider performs only the technical or professional component. Instead of 93000, you would use 93010 (Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only) if your provider’s services were limited to just providing the interpretation and report, or 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report) if your provider performed the technical component only.

Code 93224 also represents several components that can be reported separately with different codes, including 93225 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)) and 99226 (… scanning analysis with report) for the different technical components, and 93227 (… review and interpretation by a physician or other qualified health care professional) for the professional review and interpretation.

That means you should code your encounter as 93227, 93010-59 instead. And as 93010 is bundled into 93227 per National Correct Coding Initiative (NCCI, or CCI) edits, the modifier will override the edit pair.