Internal Medicine Coding Alert
Dont Double-Bill 93235 for 48-Hour Monitoring
PDF
South Carolina Subscriber
Answer: You should not append modifier -26 (Professional component) to 93224 (Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation). CPT lists a separate code for this service, 93227 (... physician review and interpretation).
You should report 93224 if the physician performs all of the described services, including hooking up and removing the monitor, analyzing the scan, and reviewing and interpreting the results. If the internist performs only some of these tasks, you should bill for the individual services only. If the internist reviews and interprets the data but does not own the equipment and does not perform any other services, you should report 93227.
Holter monitor codes (93224-93237) are for 24-hour monitoring. Some carriers will reimburse a 48-hour Holter monitor if you enter the complete service code on the first line of the CMS-1500 claim form, such as 93235 (Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient-activated; includes monitoring and real-time data analysis with report, physician review and interpretation). You should enter 93237 ( physician review and interpretation) on the second line for the second 24-hour period. Do not bill 93235 twice because many services performed for the 24-hour Holter do not need to be reproduced for an additional 24-hours.
To be safe, you should send a paper claim to the carrier along with an attachment explaining the medical necessity for 48-hour monitoring. Local policies vary, and some carriers will not pay for Holter monitoring longer than 24 hours, so you need to ask your carrier first.
Internal Medicine Coding Alert
- Think Youve Learned Your Immunotherapy ABCs? Think Again
Allergy season brings new patients into your office each day, so you must be proficient [...] - Earn $35 More per Visit With Better Medical Decision-Making
If youve been downcoding to a level-four office visit or lower just to play it [...] - You Be the Coder:
Code 90782 Multiple Times
Question: When using 90782 for injection administration, can I use this multiple times with multiple [...] - Reader Questions:
Watch Out for X-Ray Components
Question: How should I bill for x-ray interpretation when we do not own the equipment?
Illinois [...] - Reader Questions:
Avoid Unspecified Diagnosis for Hypertension
Question: Which code should we use to show the diagnosis of hypertension that is renal-disease-related? [...] - Reader Questions:
Dont Double-Bill 93235 for 48-Hour Monitoring
Question: Our internist ordered and interpreted data from a 24-hour Holter monitor. Is the correct [...] - Reader Questions:
Use V Code for Pap-Only Visit
Question: A patient came in for a well-woman visit, but the physician could not perform [...] - Reader Questions:
Code Separately for Anaphylaxis
Question: A patient came in to receive an allergy injection. She had an anaphylactic reaction [...] - Think Youve Made Your Case for Modifier -22? Not if You Havent Done These 5 Things
If youre submitting claims for unusual procedural services without first determining how youre going to [...] - Reader Question:
Choose Your Coding Poison Based on Documentation
Question: How should I decide whether managing excessive bleeding that requires extra physician time and [...] - MDM Cheat Sheet