Revenue Cycle Insider

Hint: You need to know whether a service provided is global or a component.

When patients have irregular heartbeats, providers need to rely on diagnostic services that can help them figure out exactly what’s going on. The unpredictability makes it challenging for providers trying to detect and accurately diagnose an arrhythmia. Devices such as Holter monitors help narrow down a diagnosis. Cardiovascular monitoring devices can be worn by the patient and record electrocardiographic (ECG) data for days or weeks at a time.

Last month, you read about the different types of devices. This month, find out more about how to differentiate between different services to select the appropriate code, even when the coding gets complicated!

Distinguish Between Global and Component Codes

The code selections for most devices are divided into global and component codes. The component codes describe individual parts of the whole service.

Recording codes are technical codes that include connecting the device, recording the data, and disconnecting the device. Scanning codes are technical codes that include the work of analyzing the recorded data.

To report technical codes, the provider must own the equipment. Because these are standalone “technical component only” codes, modifier TC (Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles) is not appended.

The interpretation codes cover the professional component that includes the final report by the provider after the data has been analyzed. As these are “professional component only” codes, modifier 26 (Professional component) is not required.

Global codes are reported for all of the above, encompassing both the technical and professional components of the service. The provider is responsible for the recording, scanning analysis, and interpretation. To report global codes, the provider must own the equipment. No modifier is needed.

Select the Appropriate Code or Codes for the Service

Global Holter monitor services are reported with 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) Recording is reported with code 93225 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)), while scanning analysis with report is reported with code 93226 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report). A provider only performing the interpretation would report code 93227 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional).

Mobile cardiac telemetry services are categorized a little differently. The interpretation is reported with code 93228 (External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional), while technical support from the surveillance center is reported with code 93229 (External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional).

Report Global Codes Like This

When you need to report global codes for wearable devices, you have several options. The code descriptors vary mostly depending upon which services are included.

• Global event monitor services are reported with 93268 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified health care professional).
• Recording is reported with 93270 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; recording (includes connection, recording, and disconnection)).
• Use code 93271 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; transmission and analysis) for transmission and analysis or
  • Report the interpretation with code 93272 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional).

• The global code for long-term continuous recording that lasts greater than 48 hours and up to 7 days is 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation).
• The recording is reported with code 93242 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; recording (includes connection and initial recording)),
  • scanning and analysis with 93243 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; scanning analysis with report),
  • and interpretation with 93244 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; review and interpretation).
• For continuous recording lasting longer than seven days and up to 15 days, global services are reported with 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).
• Recording is reported with 93246 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; recording (includes connection and initial recording).
• Report and scanning analysis are reported as 93247 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; scanning analysis with report).
• Interpretation is reported with code 93248 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation).

Accurate coding for wearable cardiovascular monitoring services requires a solid understanding of the devices, and an understanding of how the applicable CPT^® codes are structured. By following the three steps — knowing the device, identifying the type of service, and selecting the correct codes — coders can ensure precise reporting.

Brittany Sowards, BA, CPC, CPMC, CCC, CCVTC, Clinical Documentation Specialist