Tag Archives: Insider
12, 24, and 48 hour services all have roles in this coding shake-up.
Cardiology codes are always changing, trying to keep pace with technology and current practice. For this reason, Holter monitor codes saw big changes this year. Here’s what you need to know.
Start With a Nutshell Holter Service Description
Dynamic electrocardiography (ECG), also called Holter monitoring, involves ECG recording, usually over 24 hours. The goal is to obtain and analyze a record of the patient’s ECG activity during a typical day. The medical record usually will include the reason for the test, copies of ECG strips showing abnormalities or symptomatic episodes, the patient’s diary of symptoms, statistics for abnormal episodes, the physician’s interpretation, and documentation of recording times.
Understand Your Newly Reduced Coding Options
In 2010, you chose among the following code ranges for these services:
- 93224-93227, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage, with visual superimposition scanning
- 93230-93233, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout
- 93235-93237, Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis using a device capable of producing intermittent full-sized waveform tracings, possibly patient activated
In 2011, your coding options have changed. A new note under 93229 tells you “93230-93237 have been deleted. To report external electrocardiographic rhythm derived monitoring for up to 48 hours, see 93224-93227.” CPT® Changes 2011: An Insider’s View states that 93224-93227 have been revised to accommodate reporting the services described by 93230-93233 and 93235-93237.
CMS staffers confirmed this week that MACs can determine whether they’ll allow licensed practical nurses (LPNs) and registered nurses (RNs) to perform annual wellness visits (AWVs) and collect from Medicare for those services. That’s the word from a Feb. 22 CMS Open Door Forum, where providers called in with several questions affecting Part B providers.
One caller phoned into the forum to ask about a Q&A posted on the Web site of WPS Medicare, a Part B payer in four states, which asks whether an RN or LPN can perform “the entire annual wellness visit (AWV, G0438-G0439).” WPS responds on the site, “Yes, an RN or LPN can perform the visit. They need to be under the direct supervision of a physician and the state license needs to allow for them to do all the ocmpoennts of the service.” (http://www.wpsmedicare.com/part_b/education/awv-faq.shtml). The caller asked whether this is a general CMS policy or if it only applies to WPS Medicare.
“Remember, the LPN’s not billing,” said CMS’s William Rogers, MD, reminding the caller that the visit would be billed under the physician’s NPI as “incident to.” But the caller still considered it “odd” that an LPN could perform an AWV, since it’s similar to an E/M service.
“It’s a different sort of service – there’s not really any clinical judgment involved,” Rogers said. “It’s a service which includes a lot of sort of administrative steps, verifying that people have certain preventive services done and things like that, and so it is intended to be a collaborative service.”
Keep in mind that CMS does not have a national policy allowing LPNs and RNs to perform AWVs, but reps from the agency confirmed that it’s within the rights of the individual MACs to make this determination.
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