Hi everyone and welcome to the cardiovascular coding essential education series. We are going to cover in this module non-invasive cardiovascular studies and imaging. We're going to cover the CPT coding. This is our MedAxiom disclaimer just representing that none of this information is considered legal advice and you should always check with your local carriers. We also have a disclaimer for CPT which is copyright of the American Medical Association and it is a registered trademark. So we're going to cover an overview of the tools and technology used for cardiovascular diagnostic testing services, the CPT coding and guidelines for billing, what are the documentation requirements to support medical necessity and also any reimbursement insights. So let's start with the guidelines. So for the guidelines Medicare and all insurance carriers require an order and they have a specific definition around an order for a diagnostic test which represents a communication between that treating practitioner requesting the test to be performed on the beneficiary. Often our orders are communicated through an electronic process or they could be written. Also verbal orders to members of the clinical team are often given by a physician or an APP and these are signed by that physician or APP at a later date. In the CMS section on orders, it's not inclusive of facility certification bodies, some CPOE requirements or what your institutions may require. However, all diagnostics testing does require an order to be on file. Part of that order is to support the intent of the documentation to support medical necessity. So why are we having the tests performed? Do we have documentation to support the diagnosis, conditions, symptoms, etc. of that patient? Are we meeting the Medicare regulations or any applicable local coverage determinations? And then we also have our national Medicare coverage determinations. Commercial payers have their own requirements. And many commercial payers, including some of our Medicare Advantage plans also have authorization requirements. The order is the start of that medical necessity information and helps in supporting the coverage for the testing, the authorization process or any insurance eligibility requirements. Supervision is a part of diagnostic testing. So there are three definitions of supervision by Medicare. General supervision, which means that it's provided under the overall direction of a physician. Direct supervision, which is defined that in an office setting that the physician is located in the suite, or in that room with that test being performed. However, with direct supervision being within the suite, or what's deemed the office setting is considered direct supervision. For personal supervision, this means that the physician must be in full attendance in the room during the performance of that procedure. So each of our diagnostic testing services, based on whether it's a professional or technical service, and how it's defined in the Medicare physician fee schedule has a number that represents the supervision requirements. So by each CPT code for the diagnostic service, you can determine if it needs to meet general direct or personal supervision from the Medicare physician fee schedule. When we talk about the professional component, this represents the physician's work. This is interpreting the diagnostic tests, performing the procedure. And it also includes the direct practice and malpractice expenses that are related to the work of the physician. And many of our diagnostic services require a modifier 26 be applied, which indicates that it is a professional only component. Many of our physicians, depending on the setting in which the diagnostic test is performed, may build globally, they may build a professional component only, and that's when we would see that 26 modifier. For the technical component, this is all of the non physician work that goes into the reimbursement of that study. So any administrative personnel or capital equipment facility cost, and modifier TC is used when the billing code is indicating the technical component only. So there are times where our institution may build a technical component, and our physicians build a professional component. In that scenario, the facility would build the CPT code with the TC modifier representing technical component and reimbursement. And for the physician, they would append the 26 modifier, which would represent the physician work and the professional fees to be reimbursed. So just some tips as we recap around medical necessity, what services needed? Why are we performing the service? So what are the indications on the order? Does the reason for the service meet our national and our local coverage guidelines? Who and where will we perform the service? And do you have the appropriate order and documentation to support the service? So we need to check the boxes on all of these components when performing diagnostic services. So let's get into many of our common cardiovascular diagnostic services. This module does not include all services in the cardiovascular space, but the most common. So we're going to start with echocardiography. So for echo services, referred to as TTEs, or our trans thoracic echo services, we have codes both for adult and congenital studies. Those codes represent a complete study with Doppler and Color Flow performed, which is the standard. So that would be our 9-3-3-0-6, which is our most common echo code that we see in adult cardiology. We also have a code if they perform a complete study without the Color Flow and Doppler. We have a code for the limited study and then the congenital anomalies follow that same cadence based on if it meets the definition of congenital. So these are our trans thoracic echo primary codes. So depending on if it meets adult or congenital services, if it's a limited or a complete echo, and if they perform Color Flow and Doppler, is how we select our code for service. When we look at what a complete versus a limited echo is for our trans thoracic, these are the components that define a complete study. So this is what we would see in our report. Generally, it includes a 2D mode, you will see, M mode, it'll have the left and right ventricles and atria, it will cover all of the valves, the pericardium, the adjacent portions of the aorta, and it will also include information from that Color Flow and Spectral Doppler that includes blood flow and hemodynamics. For our trans esophageal echoes, we often hear the term TEEs. These are actually when a probe is passed, and the patient is normally under moderate sedation or full anesthesia, just depending on the program and the procedure. And these codes represent, if I perform the probe placement, acquisition, interpret and report, I'm going to build that global code that 93312. Now, if I'm the physician, I perform the probe placement, do the acquisition, interpret and report, and I am reporting the professional service only, that's when I would add 93312 with the 26 modifier, the facility would build the technical if I'm performing it in a facility. If I do place the probe only, there's a code. If I do the image acquisition, interpret and report only, there's also a code. And these are for our adult services. The congenital codes follow that same dynamic of if I perform the complete study, the probe placement only, or the interpretation and report. Oftentimes, you'll see that in cardiovascular, most physicians will perform the complete service that 93312. However, there are some programs where anesthesia places the probe. So in that case, anesthesia builds for that probe placement, and then the cardiologist may do the image acquisition, interpret and report only. So when you look at TEE services, you are going to look at is it adult congenital? And what are the components of the service that the provider is performing? There's also a code that's used at times with our electrophysiology services, the 93318. And this is when that probe is placed during that procedure and used to address those cardiac pumping functions or some therapeutic measures on an immediate time basis. It can be performed with other procedures. The most common we see building cardiovascular, particularly in our adult world, is that 93312 or the 93314. And of course, our congenital codes following that same cadence. We also have a code for a structural heart TEE. 93355 represents a TEE that's performed with our structural interventions, and they specifically specify that this can be used when a TAVR, a transcatheter pulmonary valve replacement, a mitral repair, if you're doing a left atrial appendage closure, which is our Watchman procedures. This code can be used and billed by a physician who is independently performing this from the actual structural heart procedure. So if you have a physician who's actually in the example of a TAVR performing the TAVR as an assistant, so it's an interventional cardiologist, he's doing a co-surgeon of the TAVR with the cardiothoracic surgeon, he is going to bill for the TAVR with the co-surgeon modifier, he is not able to bill for the structural heart TEE. That would have to be a totally separate, independent physician providing that service during the procedure. We also have Doppler add-on services available. So we talked about in our transthoracic echoes that it includes ColorFlow and Doppler within the study. These codes can be added on to our TEE services if performed or also added on to our limited echo services if performed. So you want to be sure that the documentation supports these services and that you know when you're able to add these on. You obviously do not want to add on these codes to a primary procedure if it's included in the description of the code. So be sure that you know which service you're billing, what's the age of the patient or their anomaly, if it's congenital or adult, and then determine limited or complete and if the code includes ColorFlow, Doppler, or any add-on service. Documentation of spectral ColorFlow and Doppler includes a short portion within your echo report, regardless of the type of echo, using the terms ColorFlow and Doppler. This is recommended best practice. We often see in the procedure list, complete echo with 2D ColorFlow and Doppler. In the detail of the report, it would support the measurements and interpretation of those components. The chart on the right reviews what those modalities are, what some of the documentation points may be in order to code for ColorFlow and Doppler, or our complete echo codes. Myocardial strain imaging is an add-on service to our trans thoracic echo services. This is a separate technology and would need to be indicated in the report as to why you are performing the myocardial strain. So what is supported in the order for the myocardial strain, and it needs to be reported within the report and the results of the measurements. The measurements are generally called GLS, or global myocardial strain, you'll see within the report. So this is an additional add-on code generally performed if your patient has aortic valve disease, or sometimes we will see this also performed with our chemotherapy patients, or any of our other congestive heart failure cardiomyopathy. The indications for this do have a local and a national coverage determination, depending on your local carrier, they may just follow the national. So you want to be sure that you review those diagnosis codes that support medical necessity for the add-on code for strain. 3D services, these are also add-on services that have been provided. The 93319 adds on to our echo services for congenital anomalies. And it can also be reported on some of our other TEE services as well. The most common code that's available and used across cardiovascular programs is the 76376, 3D that doesn't requiring imaging post processing on an independent workstation. This is again another technology that's added on, has a narrow diagnosis code to support medical necessity and varies for reimbursement by payer. The post processing code on an independent workstation, we do not see that very often. This requires that the physician is on a workstation other than the echo equipment doing some independent post processing. And this does have to be clearly documented within your report if it is supported. We'll hear the term with ECHO's bubble study. What this means is that they're injecting a saline solution during an ECHO study and giving getting images before and after they inject the solution. There is no additional code to support this service and it's included as part of an ECHO. So just want you to be familiar with that term bubble study. Our stress ECHO services, when we report stress ECHO services, we have the global service code, which is the 93350, which means I am performing all parts of that stress ECHO. And this can be pharmacological or an exercise stress test. And I'm also doing the interpretation of all those components. The 93351 is used if I am just doing the supervision portion of the study and not performing and supervising all of the components of the stress portion of the study. And normally we see that 93351 or 93350 billed with that 26 modifier for the professional services. Just depends on if you're doing these in your office setting and the physician owns the equipment, they may bill globally. Also, there is an add on code if you use a contrast agent. And this should be documented in your report. And depending on where the service is being performed, you may also bill for that pharmacological agent that goes along with the administration, depending on if you're billing this within an office place of service 11, where the practice physicians own the equipment and the services being provided, or if you're performing this within an institution, you're not billing that pharmacological agent generally. Moving on to our SPECT nuclear studies, and stress testing. So when we talk about SPECT versus planar, I think it's important to understand what those definitions mean. We often use the term nukes, SPECT, stress test, pharmacological stress. So there's many terms that are used to classify these studies. The most common is the SPECT study, which produces 3d images, the camera rotates around the patient to obtain these images at varying angles, and it reconstructs into a 3d view of the radio tracers that are distributed to the heart. When they do planar studies, which is not as common, but we do do some, this is 2d imaging, and the camera is stationary over the patient and it obtains data from that one position. So you often see the physician will document if it's a planar study or a SPECT study, or they'll document 2d versus 3d. Again, our most common is our SPECT study that we utilize within our nuclear medicine departments. These are the CPT codes for our SPECT studies, you'll also see it called myocardial perfusion, because that's what's utilized within the code. When we use these studies, often we are performing multiple studies, which is the 78452. If we do a single study only, such as a rest only, you may occasionally see that you would build that 78451. Our most common, however, is at rest and stress, which could be exercise or formological. And then you also bill for stress components, the formological piece. So we'll go over an example of that. Our planar studies are set up the same way into single and multiple studies. Again, these are not as popular as our SPECT cameras that we have in the cardiovascular departments. We do have studies that are referred to as MUGAs, M-U-G-A. These are considered cardiac blood pool imaging, or you'll hear gated studies. And these are also defined by if it's a single study, rest or stress, or if they're performing a multiple study at rest or stress. And then it gets into some different codes around wall motion, ejection fraction, and if they're doing some additional first passes, you may hear the term first pass study. So these are the codes you would use for your MUGA studies and your cardiac blood pool imaging. This is an example of what you would normally bill for a complete SPECT, multiple studies, rest, and formological. And in this example, it would represent your billing the professional and the technical service performed in your office, place of service 11, and you own your equipment. So in this example, it shows we would bill for our SPECT multiple study, that 78452. We'll bill for the radionuclide, which is the A9500. We'll bill the stress testing portion if we meet the interpretation, supervision, and report criteria. And then we'll also bill for adenosine. Another common one you'll see here for the formological stress is Lexascan. You'll see that also as part of the studies and what's billed. It's important to understand the units that you should bill when it comes to the formological piece, particularly if you're billing these services global in your office, place of service 11. If you're billing these in an outpatient hospital department, which could be place of service 22, as an example, if the physician is only doing the interpretation and the supervision of the stress test, you're going to bill that 78452, which are modifier 26. Then you're going to bill the 93016 for your supervision of the stress test and your 93018 for interpretation of the stress test. The facility would bill for the technical component of the SPECT study of the stress test, which is that 93017. And then they would bill for the formological agents. We just talked about the stress test add on codes, I won't go over the codes again, but important to understand just as in many of our codes, we have a global code that includes the technical, the supervision, the interpretation and report. And then we have unbundled codes that include the supervision, the tracing, which is that technical component, and the interpretation and report. This will be dictated depending on the place of service, where the patient is having the study performed, equipment, those types of services. One reminder is that stress test is not only exercise, it is pharmacological. So it does not have to be on a treadmill or a bicycle exercise. It can be a pharmacological stress. This is an example of those scenarios I talked about. If the physician administers a stress test, so a regular stress test without the nuclear spec scan and a place of service 11, provides supervision, owns the equipment, and interprets the study, he builds the global code, he or she. In the second scenario, this would be our inpatient or outpatient hospital services where one physician may supervise, one physician reads, and this is how that would be billed. And then also if our PAs or nurse practitioners do the supervision, that piece can be billed under them as well in the inpatient outpatient hospital setting. Moving on to our CTA and pet services in cardiovascular. So for our pet services, these services are broken down in ways such as if it is a multiple study, depending on what the use of the study is. So in that first code, the myocardial imaging, so when we talked about SPECT, it was called myocardial perfusion imaging, and we consider that SPECT. When you look at the pet example, it's called myocardial imaging as well, without that spectral piece. So this is a perfusion study that includes ventricular wall motion ejection fraction when performed. And that first code is a single study at rest or stress. Again, that stress can be exercise or formological, and it's concurrently acquired with CT transmission scan. The 3-1 is the multiple studies. The 3-2, you'll see an example here of a myocardial viability study. So I'm using a dual radio tracer in this circumstance to perform my pet service. And you'll see the next one as well. We'll talk about that I'm doing that dual radio tracer with the concurrent CT transmission scan. The 78434 is an add-on code that you can build in conjunction with the 78431 and also a 78492. And this is for myocardial blood flow. You will see the term myocardial blood flow, or you could see that they have that AQMBF. I often see that in reports as well. With cardiovascular pet studies, the most common we see build is normally that 78431. And if they do myocardial blood flow, we will see the add-on code of the 78434. This, however, is the entire code series that we often see within cardiovascular. Again, most common codes are 78431. And if you do that myocardial blood flow, you add on that 78434. So some guidance when coding for your pet services. You want to be sure you capture the correct CPT code that reflects the service that you're performing. This service has national coverage determinations and local coverage determinations at times. It can be carrier priced, meaning that each carrier is able to price the reimbursement for the pet service. You want to be sure that you're meeting the medical necessity policy. Oftentimes you're getting authorizations on these procedures, and you're going to need that clinical detail. You'll also code for any add-on services as appropriate, just in the case of our spec studies where you're adding on if they're doing a pharmacological or exercise stress test. You'll also bill for any services used to report supplies, materials, or injections, depending on if you're billing in an office setting or a hospital-based setting or a testing facility. For example, you'll commonly see rubidium used with these studies, and this is the pharmalogical HCPCS code for rubidium, the A9555. This is commonly billed in your pharmacological stress if you are performing pet studies in the cardiovascular space, so you want to be sure that you have your solid authorization processes so that you know what that carrier reimbursement will be, and if they authorize or approve that service based on the medical necessity. These are our common CT and CTA, so CT angiography codes. Again, we break down that first code, the 75571. We'll often hear the term calcium scoring, so that's our calcium scoring code that does an evaluation of coronary calcium. Those are often not reimbursed by payers. We do see a lot of programs where they offer an out-of-pocket expense to patients in order to have this performed as part of their risk factor stratification. Many times, some employers or some commercial carriers, if they're self-insured or some different examples, may cover this. However, a lot of times you will see these billed to the patient and it's out-of-pocket. I've seen them, depending on the region, range anywhere from $25 to $125 out-of-pocket. If you're doing a complete CTA, normally we would see that 75574 billed, and that would include a complete CTA that supports medical necessity, and then we also have codes for a CTA of the heart with contrast material, but when you get down to that CTA, it's covering the heart, coronary arteries, bypass grafts may be included if they have them. It'll also include evaluation of the structure, assessment of the cardiac function, and evaluation of the venous structures. The 7-2 is if you are not assessing the coronary arteries and bypass grafts, and 7-3 is the congenital scan that would represent just the CT of the heart. The CTA is our most common that we see billed, and again, that could be billed with a 26 modifier for interpretation, only if you're only doing the professional service. In addition to our CTA services, we see the term FFR. This can get confusing in our non-invasive space because we also have DFR and IFR in our cath lab procedures. In particular, for fractional flow reserve, this is referring to services that are available and technology that's available to add on to your CT service. The 0510T is the complete code, and then the other codes are the component codes based on if you're doing the data, if you are doing the analysis, and other components such as the interpretation and report only. Depending on what portion of the service you perform or if you bill this globally would drive what code you are billing. These codes do have a T on the end because they are Category 3 CPT codes, which are considered temporary codes before being moved to a confirmed CPT code. These T codes are carrier-priced and reimbursed differently across payers. It's important as part of a CT program, if you're doing CTAs and you're doing FFR, you want to be sure that you understand the components that your provider is doing in regards to the professional service and then also where is the technical being performed. If this is part of your authorization process, you really need to know on the front end if this is being performed because it may not be covered by some carriers. However, most do cover it and hopefully we will see this T code move to a confirmed CPT code in the future. Our non-invasive peripheral vascular diagnostic testing services. This includes our venous and arterial non-invasive studies. Some of the documentation guidelines for these scans, which are often referred to as duplex scans. When we think about peripheral, we also have spectral and color flow Doppler that's required to assess both flow and color and recording of the waveforms. It can include at least one of the following in the measurements, the spectral, the flow velocity, the resistance index, the wave, or the pulse. A complete duplex must include arterial inflow and venous outflow and the color flow and Doppler. That CPT code, as you'll see, includes all of those components. A limited must have at least the color flow and Doppler. We'll see both a complex study or a limited study based on what type of duplex study they are performing. Starting with the carotids, we have the duplex scan, which is of our bilateral carotids. Then we have a unilateral, one side, or a limited study. Commonly, we see that 93880 build for our cardiac duplex studies. Normally, we see the medical necessity supported with that if the patient is having a carotid brewery or if they're having syncope. Again, you want to be sure if they don't have carotid disease that you are supporting their symptoms and diagnosis prior to getting the study done so you know that patient's out-of-pocket responsibility and also the reimbursement of those services. Extremity duplex scans. These scans are determined by lower extremity arteries or upper extremity arteries. It can be a complete bilateral study for both sides or a unilateral or limited study. The documentation would include the location of the study, the arteries being assessed, if they're using ColorFlow and Doppler for the complete study, and if they're doing both sides of the body. This represents the arteries, so you want to remember if they're doing venous, those are different codes. These are for duplex scans of the extremity arteries. These represent our venous duplex codes, so this would be extremity veins. These are used as just extremity codes, so they do not separate them by lower and upper extremity veins. Just a little something to keep us on our toes, but need to understand are we looking at veins versus arteries? Are we doing a complete bilateral study or a limited unilateral study? And being able to define which duplex scan code we should use based on that venous or arterial service. We also have a duplex scan code for the aorta, which is a complete study. You must report on not only the aorta, you must have findings in the inferior vena cava, the iliac, and if there are bypass grafts, so that would represent a complete study. If you're reporting on the aorta only, that could represent a limited study, so you want to be sure again that you understand what's being reported. Normally, I would say in the indications and the procedures performed, the physicians are pretty good about indicating if it's a limited study. The majority of studies are complete studies and include all of the components, so when they call out a limited study, you just want to be sure that you're paying attention to that heading and then looking in the body of the report to understand if all the areas are being reported for a complete study or if it's only covering one area that would support a limited study. We also have extremity arterial studies that are not duplex studies, so these are considered physiological studies of the upper or lower extremities, and they are separated by limited, complete, and depending on if they perform a stress portion with these as well. You may hear these referred to as plasmography also. This is a patient is hooked to a machine that has four blood pressure cuffs, two on the upper, two on the lower extremities, depending on what they're measuring. That's just an example. It's not using a probe or a doppler to get a duplex scan. This is more of that physiological study, and oftentimes it is dependent on what levels you are reporting based on the extremity arteries, so we're going to provide some detail of that in the next couple of slides. The lower extremity requirements, which is considered limited for that 93922, this specifies what are the one and two levels that you need to report on, and it gives you three options. So in your report, you want to be sure that you have documentation on one to two levels that supports the doppler waveform recording and analysis. It may also include some different measurements at that level, and if you're doing different portions, you may see toe raises, you may see other methods that they're using with these studies, but again this would be considered a limited study where you're focused on one or two levels, which for an example may be your posterior tibial and anterior temporal arteries. For the upper extremity limited, same concept, but you're focused on those upper extremity one or two levels. You're getting those systolic pressures, and you're either looking at the plasmography or the oxygen tension measurements or waveform. So it's important when you look at these codes and you look at the detail that you see that term R. It's not and. So when you're reporting limited, it's meeting one of these three requirements at the one or two levels based on if you're doing upper or lower extremity arteries. For a complete lower extremity, this is where the code breaks down again into an R scenario based on four different functions, and this is at three or more levels. So limited one or two, 93923 represents three or more levels, and again looking at those ABIs at different portions. So that ankle brachial indices for these particular studies are ABIs. You may see them referred to as this is an extensive ABI that's being performed on equipment. This is not just a Doppler ABI service. This is truly an independent study that represents the physiological information of the extremity arteries. When you look at upper extremities, same thing. You're looking at those three or more levels. So documentation is essential here to understand the pressures being measured, the waveform, or if they're using any type of other functional maneuvers to measure both upper or lower extremities, and you're capturing the complete information at three or more of those levels. Moving to cardiac monitoring. So cardiovascular monitoring services, we're going to cover some of the AMA definitions. This technology is ever-changing in our cardiovascular space. So we've gone over echocardiograms, which is a type of sonogram. We've gone over duplexes, which is also somewhat a sonogram. We've gone over physiological testing, stress testing, stress testing with imaging modalities. Now these are physical cardiovascular monitors that may be utilized to look at arrhythmias as an example in your patients, or if they're having some symptoms. We've had our standard Holter monitor codes. These have been in place a while, the 9-3-2-2-4 and 9-3-2-2-7. This includes up to 48 hours of continuous monitoring. So you're wearing this equipment for 48 hours, it's recording continuously, and you are documenting in a little diary if you have any symptoms. The way the codes are broken down for our Holter monitors is based on if you're billing the global service of the hookup and disconnect, the actual interpretation or tracings, and then the actual interp of those tracings. And then you have your codes, the 9-3-2-2-5, 2-6 and 2-7, that recognize the individual components based on what you're billing for those services. New technology, we now have these long-term continuous recorders. These continuously record and store for greater than 48 hours or up to seven days, or for greater than seven days up to 15 days. So the billing really depends on how long am I going to wear it. This you may hear referred to as a patch monitor. There's several brands, but ZioPatch is one. There's many of these patch monitors out there. One thing to remember is that sometimes the technology supports with these patch monitors that they have multiple functions. They can be a long-term continuous recorder for 7 to 15 days, they could be a mobile cardiac monitor, or they could be some type of event recorder. So it's important to understand what that technology is so that you know which series of codes that you're billing. For mobile cardiac monitors, these are monitors that are truly transmitting all the time, the patient's wearing it, and they're being monitored by a surveillance center. So the codes support if you're providing that 24-hour attended monitoring, and it's continuously recording in that scenario. These have many coverage guidelines based on payers, and it's important to have the medical necessities to support. Oftentimes payers may require that the patient have a patch monitor or a Holter monitor prior to moving to our mobile cardiac monitors, which are also referred to as MCOTs or MCTs. This is definitely newer technology, however is something that we see used often, particularly if it's hard to capture a patient's symptoms within 48 hours, 7 days, or 15 days. Event monitors are a bit different and actually record segments that are triggered by the patient. So the patient would normally have to press a button, they can't transmit immediately, and they're truly based on algorithms that have been set up for the activation of the recording. They do also require that attended 24-hour surveillance, and you may be billing the interp only of these depending on if you provide the technical components of the surveillance, etc. So many different types of technology, these are the most common ones. This represents a cheat sheet for billing and coding. Just as we talked about our Holter monitors, you can see those break down our continuous monitors for up to 7 days, and our continuous monitors up to 15 days. They have a global code, a code for the recording only, a code for scanning only, or a physician review and interpretation code only. So it's important to know what type of services are you providing, what type of monitor, and then again does the order support the medical necessity that's included in the documentation. For our mobile telemetry, our ambulatory monitors, you can see I have the abbreviations MCOT, MCT, and ACT. It talks about as well that technical support, so if you're not providing the technical support of that attended surveillance, and you're only billing that professional interpretation, then you're going to bill that 9-3-2-2-8 code. If you're not having that attended surveillance, you're going to report that with your 26 modifier indicating you're doing the interpretation only. Cardiac event monitors, again these are the ones that have to be triggered, and they're downloaded and generally store 30 days worth of data. They do require that 24-hour monitoring, and they also have their code services broken down. When billing for our arrhythmia services, it's important to understand what did the provider order. You should query your provider if you're unclear on that, because as you begin getting authorizations in these, sometimes they do have some coverage policies that represent that some of these monitors may be experimental, and you want to be sure that you're getting the correct coverage for your patient, and that you're understanding the technology. If you use multiple types or brands of these monitors, you also want to be sure that the entire clinical staff, schedulers, and the physician team know what's available, know what these monitors are called. We often see terms used interchangeably, which sometimes can lead you to the wrong code, so you want to be sure you have all of that information to support the type of monitor that you're providing to that patient to support reimbursement. This concludes our session on non-invasive cardiac diagnostic testing. Please send us any questions at revenuecyclesolutions at medaxiom.com. You'll also have a post-test regarding this module. Thank you.

non-invasive cardiovascular studies

imaging

cardiovascular diagnostic testing services

CPT coding

billing guidelines

documentation requirements

medical necessity

reimbursement insights

compliance with Medicare regulations