Cardiology Coding Alert

Question: My cardiologist has been performing Holter monitoring. I see in the code descriptors for 93224-93227 that I should report these codes when my cardiologist performs up to 48 hours of continuous recording. However, a colleague mentioned that we needed to append a modifier to the Holter code if our cardiologist uses a Holter monitor for less than 12 hours. Can you please explain what modifier we should use in that case?

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Answer: In the CPT^® guidelines for codes 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)-93227 (… review and interpretation by a physician or other qualified health care professional), you will see a note that specifies when there are less than 12 hours of continuous recording, to use modifier 52 (Reduced services). For example, say your cardiologist attaches a Holter monitor to the patient for seven hours of continuous recording to detect abnormal heart rates and rhythms. Your cardiologist performs all of the components of the monitoring service including the connection, the scanning analysis and report, and the review and interpretation. Since seven hours is less than 12, the coding note applies here. You should report 93224-52 on your claim because your cardiologist only performed seven hours of continuous recording.

Holter monitor defined: A Holter monitor, also known as dynamic electrocardiography (ECG), monitors and records a patient’s heart rhythm.