Cardiology Coding Alert

Question: A patient who is suffering heart palpitations reports for waveform Holter monitor testing with visual superimposition scanning. The cardiologist oversees the recording, hookup, and removal of the monitor, and performs review and interpretation of the results. We outsource the scanning analysis. Because we did not perform part of the service, should I include modifier 26 or TC on this claim?

New York Subscriber

Answer: You should not append modifiers 26 (Professional component) or TC (Technical component) to any Holter monitor test code; CPT provides separate codes for each of the components.

On the claim, you should report the following:

• 93225 (Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original  waveform recording and storage, with visual superimposition scanning; recording [includes connection, recording, and disconnection]) for the monitor recording, hookup, and removal

• 93227 (... physician review and interpretation) for the review and interpretation

• 785.1 (Symptoms involving cardiovascular system; palpitations) linked to 93225 and 93227 to represent the patient's palpitations.

The entity that you used for the scanning and analysis (93226, ... scanning analysis with report) would report that portion of the service.