Cardiology Coding Alert

If you're billing pharmacological intervention with 93660 in a hospital, think again If your cardiology practice can't keep tilt-table test coding guidelines straight, you're not alone. Our experts show you how to nail down 93660's requirements in four simple steps. Cardiologists who treat patients with recurrent syncope (780.2, Syncope and collapse) often perform tilt-table tests (93660, Evaluation of cardiovascular function with tilt-table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention). But if you're not following the tilt-table testing requirements to the letter, you may find yourself facing denials for these pricey procedures. Tilt-table testing helps the cardiologist diagnose and categorize forms of reflex-mediated syncope (also known as neurally mediated, vasodepressor, neurocardiogenic or vasovagal syncope). This test should only be performed after other potentially harmful causes have been ruled out by history, physical examination, or other appropriate tests. A lack of preliminary evaluation may cause your claim to be denied. 1. CPT 93660 Includes Pharmacologic Intervention in Hospital Setting No optimal duration for tilt-table testing exists, but without pharmacologic intervention, most studies cite tilt test durations of 30 to 45 minutes at 60 to 80 degrees as the most widely accepted range for older adolescents and adult patients. If the results remain undiagnostic after that period of time, technicians, as a second-stage approach, will administer isoproterenol infusion or sublingual nitroglycerine. You should not bill for the cost or administration of these pharmacologic interventions in a hospital setting, because like the ECG and blood pressure monitoring, 93660 includes all aspects of the test. If, however, you administer the testing in the cardiologist's outpatient office, you can report the pharmacologic interventions separately. 2. Cardiologist Must Be Present Although coding experts often debate whether the cardiologist must be present during the tilt test procedure because of the low risk to the patient, most carriers require the cardiologist to be physically in attendance or close by should a problem arise. "This could be for liability reasons or hospital policy," says a Missoula, Mont., subscriber and coder for a multi-cardiology specialty office. "The patient's heart rate and blood pressure could bottom out."

Some insurers may deny your claim if you don't document the physician's personal supervision, while some payers only require direct supervision. You should therefore always confirm your payers'policies in writing before you report any tilt-table testing codes. 3. Document History, Physical Exam, and Test Report You should always submit documentation supporting medical necessity with each tilt-table test claim. The Empire Medicare policy (a Part B carrier in New York) dictates that medical record documentation must include the following information: A history detailing the frequency and length of the syncopal episodes, triggering events, comorbid illness, medication [...]