Cardiology Coding Alert

Question: We are getting a tilt table soon, but until then, our cardiologists are trying to mimic a tilt table using this method: The patient lies flat on a table (not a tilt table) for 30 minutes while being hooked up to an ECG and blood pressure monitor. Then the patient stands for 20 minutes while his/her blood pressure is monitored every 5 minutes. Is it appropriate to bill for 93660 (evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention)?

Anonymous OH Subscriber

Answer: You cant use the tilt table code for two reasons:

First, unlike the regular ECG, that procedure includes intravenous access in addition to non-invasive blood pressure cuffs. The American College of Cardiology describes it as follows: After baseline hemodynamic and rhythm determinations are made for 15 minutes, the head of the table is advanced to 70 to 80 degrees for about 20 to 60 minutes. If no abnormalities are found, the cardiologist may elect to do an isoproterenol infusion to increase the heart rate at least 25 percent. If, after 45 minutes, the patient still doesnt respond, sublingual nitrates are often given. If a positive response is encountered, the patient is placed in the supine position, sometimes with fluids and/or atropine administered to reverse any bradycardia.

Second, the specific purpose of the tilt table test is to evaluate the patients susceptibility to syncope. A regular ECG has more than 50 diagnosis codes that support medical necessity. Thus, depending on the diagnosis, a tilt table may or may not be payable.

Note: Previously, Medicare considered tilt table testing to be an investigational procedure. As of January 1, 1999, however, they are payable only if the diagnosis is 780.2 (syncope and collapse).

Therefore, in this case use 93000 (electrocardiogram, routine ECG with at least 12 leads; with interpretation and report) because it best fits the procedure you described.