Health Information Management

Q/A: Billing telemetry daily monitoring

APCs Insider, November 20, 2009

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Q: Can our hospital code and bill telemetry daily monitoring in conjunction with a chest pain patient in observation?
A: No CPT code exists for cardiac telemetry daily monitoring, but revenue code 732 does. Consider revenue code 732 an ancillary revenue code, and use it in conjunction with these services when provided by a separate department with specially-trained staff.
Typically, separate department staff members do not perform cardiac telemetry monitoring. Instead, a facility installs telemetry monitors on a specific nursing floor, enabling staff members there to observe. Medical staff members usually admit patients to that particular nursing floor because telemetry is medically necessary and a physician orders it. This means that most patients on that floor receive telemetry.
The typical nursing cost center includes the cost of equipment and staff on this unit. This means that the telemetry is a routine cost, as confirmed by administrative decisions by the Medicare Provider Reimbursement Review Board (PRRB). Because it's a routine cost, you may not bill this service with an ancillary revenue code, such as 732.
Hospitals have has two choices when billing routine costs:
  1. Include the charge in the room and board rate (or hourly observation rate) for that nursing unit.
  2. Separately bill a charge with a recognized routine cost revenue code, such as 230. This allows hospitals to separately bill a line item charge on both inpatients and outpatients. However, note that this particular revenue code is not allowed on outpatient claims. Therefore, depending on the capabilities of an individual hospital’s billing system, it may be able to include charges in the observation hourly charge under revenue code 0762 if the units of service equal the documented hours of observation. Alternatively, establish an observation hourly rate for this area that includes the telemetry charge reported under revenue code 230 for inpatients plus the observation charges reported under revenue code 762. 

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