Wiki holter monitor 93224

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cmurphy52

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When we bill 93224 Medicare is appending the 51 modifier and reducing the fee as multiple procedure stating in their policy there is a TC and PC code in 93224 making eligible for the multiple procedure reduction. We have tried appealing this since we are billing it as a single code to no avail. Can anybody explain how they are getting away with this reduction using the TC and PC Holter codes making it eligible for multiple procedure?
 
HI...I bill Holter Monitors in PA. I don't know if that makes a difference or not. I do not use 93224. I use a hook up code (93225) and a professional (93227) without a modifer. Now depending if it is a Telemetry Monitor (93228) or event (93272), the hook up and professional is coded that day, and the other is the next day and however long they wear it but only as 1 day charge. I got a lot of help from the Rep for the company, I would suggest calling them as well. I hope this helps
 
No, we are not billing any other procedure on this day of service. Medicare is appending the 51 modifier and telling us according to their fee schedule the code is a #6 and fits into the multiple procedure reduction even though it is billed as stand alone. I wish I knew how they were getting away with this. The other way billing the placement and then the reading gets lower reimbursement and one of those codes is also subject to their multiple procedure reduction (51). Please check your EOB's and see if Medicare is putting the 51 modifier on your 93224 when billed completely by itself.
 
Holter Monitors

We also bill the 93224 for the holter but my question is can we also bill a nurse visit 99211 with the holter?
 
We bill the global fee for the 93224 and do not bill a nurse visit. The patient returns the Holter monitor to us and has no interaction with the nurse.
 
Ok I just figured you were billing another service that day. We do not bill 93224 due to not owning our equipment so I am not having this issue. I looked back over the list and it looks like the global code has two TC portions if you think about it-- it can be broken down to 93227( which would be your interp) and then 93225 and 93226 which would be your TC portion. I am not saying it is right to reduce payment but by their list they are processing the MPR right due to the 93225 and 93226.
 
Final Outcome of Holter Issue

Our cardiology practice is currently expeciencing the same issue of MPPR reductions on our 93224 code. Appeals have been denied but the reasoning for the reduction did not make sense (verbal, nothing in writing). Have you had any success in achieving the correct payment for your complete holters? How is Medicare getting away with these deductions?
 
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