Wiki Zio Patch

[KoBee]

We are providing the device and providers are reviewing and interpretation. we do not do the scanning analysis; report is reported back to our providers from outside source of device.

Our providers are wanting to bill CPT 93246 & 93248, are they supposed to be billed out when the patient comes in for placement of device with instructions given? or should we not code/bill these charges until patient comes back for removal and provider reads results?


I am little confused on when these procedures are to be billed out. How can we bill out 93248 if we don't have a report yet.

If patient comes in for placement and instructions, we should only be billing CPT 93246
when the patients comes back and results are reviewed and interpret, we should then bill CPT 93248

am i correct?


Any help is appreciated, thank you.

 

[CBLENNIE]

Can I ask why you wouldn't bill the combo code 93245 that includes:

• External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording (includes connection and initial recording) represented by 93246 and
• External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation represented by 93248?

93245-External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation.

You would bill the global procedure 93245 upon completion of the testing period and bill the claim with the DOS range during which the patient was wearing the device and it was recording and the period of time of the report your providers generated.

 

[CathiMc]

Can I ask why you wouldn't bill the combo code 93245 that includes:

• External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording (includes connection and initial recording) represented by 93246 and
• External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation represented by 93248?

93245-External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation.

You would bill the global procedure 93245 upon completion of the testing period and bill the claim with the DOS range during which the patient was wearing the device and it was recording and the period of time of the report your providers generated.

What if the patient had the Zio applied but the device was not returned?

 

[CBLENNIE]

What if the patient had the Zio applied but the device was not returned?

At that point I don't believe a commercial payer is going to cover the cost of the device and you would need to bill the patient for the cost of the device. I would think that in the paperwork that the patient receives when the Zio patch is applied includes information regarding what happens if they do not return the device, typically that they will be solely responsible for paying for the cost of the device.

I would think you could still bill commercial insurance for the 93245 since these services were performed and the issue is that you didn't receive the device back and it must be paid for.

I don't know what the rules are for Medicare and Medicaid for billing the patient for the device if they do not return it. You'll have to find someone who is a cardio specialist that deals with these devices on the regular and see if they have any insight into how Medicare and Medicaid allow you to handle the issue of the patient not returning the device.