Cardiology Coding Alert

Question: What CPT^® code should I use for reporting cardiovascular tilt table testing? I have heard about two possiblecodes: 95921 and 93660.

North Carolina Subscriber

Answer: To report the tilt table test you describe, you should use 93660 (Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention).

Physicians use a tilt table test to evaluate patients when they experience symptoms of syncope (R55), the loss of consciousness and posture more commonly known as recurrent fainting or passing out. Medical conditions that may cause syncope include vasovagal syndrome, arrhythmia, structural heart disease, heart attack, and cardiomyopathy ventricular dysfunction. Remember, if the cardiologist documents a definitive diagnosis, you should report the code for that diagnosis.

In a tilt table test, the patient lies strapped to a table while the table slowly tilts upward. This “tilt” simulates transitioning from a lying down position to a standing up position, helping to trigger the patient’s symptoms. During the test, the doctor monitors the patient’s blood pressure and heart rate for any changes that might occur. The doctor may need to administer isoproterenol or mechanical manipulation of peripheral blood flow with a variety of compression devices to produce the symptoms of syncope.

Note: If the physician performs the test in a facility setting, append modifier 26 (Professional component) to the test code 93660.

ANS: On the other hand, to report autonomic nervous system (ANS) function testing instead of cardiovascular testing, choose a code like 95921 (Testing of autonomic nervous system function; cardiovagal innervation [parasympathetic function], including 2 or more of the following: heart rate response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15 ratio).

When a provider performs ANS testing, he determines the functionality of the autonomic nervous system by using an electrocardiogram to monitors the patient’s response to deep breathing, the Valsalva maneuver, and standing. Additional options for autonomic system function testing include 95922, 95923, 95924, and 95943.

With 95921, a tilt table may be used, but is not required.