Primary Care Coding Alert

Family physicians may use one of several monitoring techniques to evaluate patients with possible cardiac arrhythmias, including long-term EKG monitoring and cardiac event monitoring. Each method is described by distinct sets of codes that distinguish between the type of equipment used and how the data are reported. Because the codes are similar, however, one set is often mistakenly reported when, in fact, another service has been provided.
 
According to Michelle Ashby, CRNP, who practices with The Heart Group in Lancaster, Pa., each modality gathers information about abnormal rhythms. One category monitors cardiac activity continuously, while the other is designed to record data only when cardiac symptoms occur. And, cardiac monitoring may be conducted over a short time (e.g., 24 hours) or during a longer time (e.g., 30 days). The final variable reflects how the data are reported to the physician: It may be transmitted electronically, or the patient may bring the monitoring device back to the office.
Long-Term EKG Monitoring  
When a patient presents with indications like dizziness or giddiness (780.4), shortness of breath (786.05) or palpitations (785.1), family physicians may order long-term EKG recording to assess whether a cardiac condition is contributing to the symptoms. Sometimes referred to as Holter monitoring, long-term EKG monitoring provides a continuous record of the electrocardiographic activity of the patient's heart. "Patients are hooked up to a single-lead recorder for 24 or 48 hours and wear the monitor during their daily activities," Ashby says. At the end of the assessment period, patients return the monitor to the physician, and the recordings are reviewed in the office.
 
This type of continuous monitoring is reported with codes from the 93224-93233 series, although two methods are represented within the code family:
   
1. Superimposition scanning. Family physicians say they most frequently use procedures described in 93224-93227. Within this set, 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) is the global code, while each of the subsequent three codes describes components of the overall service, i.e., 93225, ... recording (includes hookup, recording, and disconnection); 93226, ... scanning analysis with report; and 93227, ... physician review and interpretation. These four codes are used to report services conducted by specially trained technicians who visually scan patient waveforms generated by the monitor. These are then compared with a normal waveform to identify discrepancies.
 
2. Microprocessor analysis. The second set of long-term EKG monitoring codes within the series 93230-93233 does not use superimposition scanning. Instead, a microprocessor analyzes the data and produces a printout of all recorded data in a miniaturized display. Again, 93230 (electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and [...]