Cardiology Coding Alert

Confused by 48-hour Holter services? Here's your answer.

CPT 2011 may not completely swap your old cardiovascular monitoring codes for new ones, but that doesn't mean you can ignore the revisions to this section. Here's the lowdown on changes to Holter, mobile cardiovascular telemetry (MCT), and event monitor codes.

Good news: One of the goals of changing the codes and accompanying guidelines was to reflect new technology, making accurate reporting of the services easier, according to Kenneth P. Brin, MD, PhD, FACC, CPT editorial panel member, and James Blankenship, MD, FACC, FSCAI, relative value update committee member, in the presentation they prepared for the AMA's CPT and RBRVS 2011 Annual Symposium.

Catch the Holter Monitor Time Change

In 2011, Holter monitor codes merit a single unit for up to 48 hours. In 2010, the code specified "for 24 hours." Here's how the old and new codes compare:

• 2010: 93224-93227 -- Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage, with visual superimposition scanning...
• 2011: 93224-93227 -- External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage ...

Tip: CPT guidelines instruct you to append modifier 52 (Reduced services) for less than 12 hours of continuous recording.

Heed New 'Do Not Report' Rules for MCT

The MCT codes simply change the first word of the definition from "wearable" to "external":

• 2010: 93228-93229 -- Wearable mobile cardiovascular telemetry ...
• 2011: 93228-93229 -- External mobile cardiovascular telemetry ...

But that minor change isn't all that's new for these codes. Notes with 93228 now clearly instruct you not to report the code with Holter monitor codes 93224 or 93227. And notes with 93229 tell you not to report it with 93224 or 93226.

CCI news: Correct Coding Initiative (CCI) version 17.0, effective Jan. 1, 2011, for physicians, goes an extra step to ensure you aren't reporting MCT and Holter monitor codes together.

In the past, CCI permitted you to use a modifier to separate the edits bundling MCT device codes 93228-93229 with Holter monitor codes 93224-93227. The new version of CCI puts a stop to that, adding a "0" indicator to these code pairs, according to Frank Cohen, MPA, MBB, of the Frank Cohen Group, in his Dec. 14, 2010, "NCCI Version 17.0 Change Analysis."

The edits also change the indicator to 0 for edits bundling MCT codes with event monitor codes 93268-93272, discussed below. The 0 indicator means you may not use a modifier to override the edit.

Insert 'Auto Activated' in Event Recorder Codes

Like the Holter and MCT codes, the event recorder codes exchange "wearable" for "external," bringing consistent vocabulary to the monitoring services codes. More importantly, the 2011 codes add that 93268-93272 are appropriate for auto activated recording when performed:

• 2010: 93268-93272 -- Wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time ...
• 2011: 93268-93272 -- 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 ...

Keep in mind: CPT 2011 deletes codes 93012 and 93014 (Telephonic transmission of post-symptom electrocardiogram rhythm strip[s]...). In 2011, you should report those services using event recorder codes 93268- 93272, Brin and Blankenship's presentation stated.