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The procedure described by CPT® Code 93660 involves the evaluation of cardiovascular function through a tilt table test, which is a diagnostic tool used primarily to investigate the causes of syncope, commonly known as fainting. This test is essential for understanding how the cardiovascular system responds to changes in posture, particularly when a patient transitions from a supine (lying down) position to an upright position. During the procedure, continuous electrocardiogram (ECG) monitoring is employed to track the heart's electrical activity, while intermittent blood pressure monitoring is utilized to assess the patient's blood pressure at various intervals. The tilt table itself is equipped with restraints to ensure the patient remains securely in place as the table is tilted. Initially, the patient is positioned supine, and once the ECG electrodes and blood pressure monitor are in place, the table is tilted to a 60-degree angle. This angle is maintained to observe the patient's cardiovascular response, including heart rate and blood pressure changes, as well as any episodes of syncope. If the initial tilt does not induce syncope, a pharmacological intervention may be administered intravenously to provoke a response, after which the test is repeated. The entire process is carefully monitored to document any significant changes in heart rate, blood pressure, or the occurrence of syncope, providing valuable insights into the patient's cardiovascular health.
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The tilt table evaluation described by CPT® Code 93660 is indicated for patients experiencing unexplained syncope or recurrent fainting episodes. This procedure is particularly useful in diagnosing conditions related to autonomic dysfunction, orthostatic hypotension, or other cardiovascular abnormalities that may lead to syncope. The tilt table test helps to determine whether the fainting episodes are due to a physiological response to changes in body position or if they are indicative of a more serious underlying cardiovascular issue.
The procedure begins with the patient being positioned supine on the tilt table, where ECG electrodes and a blood pressure monitor are applied to ensure continuous monitoring throughout the test. The patient is secured with restraints to prevent any movement during the tilt. Once the patient is ready, the tilt table is raised to a 60-degree angle. This position is maintained to observe the cardiovascular response, including heart rate and blood pressure changes. The healthcare provider closely monitors these parameters for any signs of syncope or significant cardiovascular changes. If the initial tilt does not induce syncope, a pharmacological agent may be administered intravenously to provoke a response. This agent is chosen for its ability to cause venous pooling or increase adrenergic stimulation, which can help elicit a cardiovascular response. After the pharmacological intervention, the tilt table test is repeated to assess the patient's reaction. Throughout the procedure, any hypotensive changes in blood pressure, episodes of bradycardia (slowed heart rate), or occurrences of syncope are meticulously documented for further analysis.
After the tilt table evaluation, the patient is monitored for any residual effects of the test, particularly if pharmacological agents were used. It is essential to observe the patient for any delayed reactions, such as hypotension or bradycardia, which may occur after the procedure. The healthcare provider will assess the patient's overall condition and provide appropriate post-procedure care instructions. Patients may be advised to rest and hydrate following the test, especially if they experienced any symptoms during the procedure. Documentation of the test results, including any significant cardiovascular changes or episodes of syncope, is crucial for further evaluation and management of the patient's condition.
| Short Descr | TILT TABLE EVALUATION | Medium Descr | CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR | Long Descr | Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring and intermittent blood pressure monitoring, with or without pharmacological intervention | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 1 | CCS Clinical Classification | 203 - Electrographic cardiac monitoring |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | ET | Emergency services | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2013-01-01 | Changed | Guideline information changed. |
| 1992-01-01 | Added | First appearance in code book in 1992. |
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