Don’t know how to bill for the professional component of cardiac telemetry services? Use CPT code 93228! Continuous monitoring is essential for patients’ well-being, especially for those who are critically ill or have a cardiac condition. But how do you bill for the interpretation of this service?
Many coders make the mistake of attaching modifier 26 to cardiovascular monitoring codes. However, we are here to tell you that the professional interpretation of cardiac monitoring has a separate code. Read on to understand the specifics of the 93228 CPT code, including what it covers and how to report it properly.
CPT Code 93228 – Description
The American Medical Association maintains CPT code 93228 under the cardiovascular monitoring service codes. It specifically refers to the professional component of an external mobile cardiac telemetry service.
In simple terms? Healthcare providers use this code to explain that they have reviewed, interpreted, and created a report from the data collected over 30 days of electrocardiographic (ECG) monitoring. This data is collected 24/7 from a small, portable (often wearable) device in a remote monitoring center.
The primary purpose of extended monitoring? To quickly detect and respond to abnormal heart activities. In short, you can think of the 93228 CPT code as a physician reading and reporting cardiac telemetry results.
Scenarios Where CPT Code 93228 is Applicable
So, when can you apply CPT code 93228? Here are some specific scenarios:
Interpreting the Results of Post-Heart Attack Monitoring
Did you know that every year, 805,000 people in the U.S. have a heart attack? The real concern lies in what happens afterward. Many people develop arrhythmias following this cardiac event due to damage to the heart muscle. They are also at a higher risk of another heart attack. That’s why healthcare providers continuously monitor such patients.
So, for this example, let’s consider a similar situation. Suppose a 65-year-old man with diabetes has recently had a minor heart attack. To reduce the risk of another cardiac event or a stroke, the physician suggests continuous monitoring via an external, portable device.
The remote center collects the patient’s data for 30 days and sends it to the physician for interpretation. The healthcare provider reviews, interprets, and reports the results, then uses CPT code 93228 to bill for this professional service.
Detecting Atrial Fibrillation via Heart Palpitation Monitoring
Heart palpitations are common, especially among people with anxiety. In fact, around 6 to 11% of people experience palpitations in a year. Healthcare providers often monitor this condition to detect and manage potential underlying heart issues.
So, for this example, consider a 25-year-old office worker with anxiety. She visits a cardiologist after experiencing frequent palpitation symptoms, including pounding and fluttering in her chest. The physician evaluates her condition and orders external mobile cardiac telemetry to rule out atrial fibrillation.
After collecting data for 30 days, the cardiologist reviews the transmitted ECG tracings and interprets them. He then uses CPT code 93228 to report the professional component of continuous monitoring.
Minor Pneumothorax Monitoring
People with pneumothorax (collapsed lung) are at a higher risk of cardiac arrest and other heart complications. Hence, they require continuous monitoring. For the final example of CPT code 93228, consider a 38-year-old man with a minor pneumothorax.
He does not require surgical intervention but is at risk of developing arrhythmias and even cardiac arrest. To closely observe his heart activity, the healthcare provider orders external mobile cardiac telemetry.
The device continuously records the patient’s data over the next month, after which the physician reviews and interprets the results. The billing team then files a claim for this professional component using the 93228 CPT code.
Applicable Modifiers for CPT Code 93228
Since CPT code 93228 already represents a professional component of cardiac telemetry, you don’t have to apply modifier 26 to this code. However, you can use the following modifier with this code, depending on the situation.
Modifier 59
Did you provide another service to the same patient on the same day? Append modifier 59 to CPT code 93228 if the interpretation of cardiac telemetry was distinct and separate from that of other services or procedures performed.
CPT Code 93228 – Billing & Reimbursement Guidelines
Want correct reimbursements for CPT 93228? Just follow these steps:
Verify Coverage and Authorization Requirements
Check each payer’s coverage and pre-authorization rules for cardiac telemetry. For Medicare, CPT code 93228 is active, so it is covered.
Use CPT Code 93228 Correctly
As we have mentioned numerous times, the 93228 CPT code only refers to the professional component of cardiac telemetry. Hence, use it only if you have interpreted and reported continuous ECG data. Avoid using it to bill for the technical component of extended cardiac monitoring.
Avoid Duplicate Claims
You can only bill for this professional component of cardiac telemetry once per monitoring episode (30 days of continuous monitoring). Hence, avoid filing additional claims for the 93228 CPT code within the same 30 days.
Maintain Complete Documentation
Don’t forget this most important step! Your documentation should be complete and legible. To avoid denials, record the following details for this professional component:
- Date of service (the date the patient was initially placed on the monitor)
- Total monitoring episode (1 to 30 days)
- Clinical findings
Summary
You don’t need to use modifier 26 to bill for the professional component of continuous cardiovascular monitoring. Simply use CPT code 93228! This code helps you notify payers that you have reviewed and interpreted the transmitted 30-day ECG data. We have provided a detailed overview of this code, including a description and three real-world examples, along with the best billing tips.
Therefore, we hope that you feel more confident, at this point, about filing a claim for the 93228 CPT code. But don’t worry if you are still unsure, as you might not be the only one. A professional with reliable cardiology billing services can help you with your coding. So, choose wisely to maximize your revenue.
