Monday, March 6, 2017

CPT 93224, 93225, 93228 , 93229 - ECG monitoring WEM

CPT/HCPCS Codes

Group 1 Paragraph: N/A

Group 1 Codes:
93224 Ecg monit/reprt up to 48 hrs
93225 Ecg monit/reprt up to 48 hrs
93226 Ecg monit/reprt up to 48 hrs
93227 Ecg monit/reprt up to 48 hrs
93228 Remote 30 day ecg rev/report
93229 Remote 30 day ecg tech supp
93268 Ecg record/review
93270 Remote 30 day ecg rev/report
93271 Ecg/monitoring and analysis
93272 Ecg/review interpret only


Coverage Indications, Limitations, and/or Medical Necessity

Long-term wearable electrocardiographic monitoring (WEM) is a diagnostic procedure that provides a record of the heart rhythm during daily activities. This procedure can often identify the existence and determine the frequency of clinically significant rhythm disturbances and waveform abnormalities that are missed on a standard electrocardiogram (ECG).

WEM are generally classified by the following:

Non-Activated Continuous Recorders (holter monitor/external electrocardiographic recording) (CPT codes 93224 – 93227) provide a continuous record of heart rhythm during a 48 hour period. This procedure can often identify the existence of ECG rhythm derived elements that are missed on a standard ECG.

This service is appropriate when arrhythmias are known or suspected to occur at least once in 48 hours 

Patient/Event-Activated Intermittent Recorders (loop event monitors, remote cardiovascular monitoring) (CPT codes 93228, 93229, and 93268 - 93272) are indicated when symptoms are sporadic to establish whether or not they are caused by transient arrhythmias. 

This service is an appropriate alternative to 48 hour monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope or syncope) or when a 48 hour service is not diagnostic.

Indications

The covered indications are:

To detect, characterize and document symptomatic transient arrhythmias.

To aid in regulating anti-arrhythmic drug dosage.

To aid in the search for the cause of unexplained syncope, dizziness or giddiness.

To monitor patients who have had surgical or ablative procedures for arrhythmias, since post ablation atrial fibrillation can be asymptomatic.

To aid in the search for the cause of TIA/CVA.


Limitations

A WEM service is medically unnecessary if it offers little or no potential for new clinical data beyond that which has been obtained from a previous test or if other tests are better suited to obtain the clinical data relevant to the patient’s condition. 

A test may be ordered only by a physician or other qualified health care professional treating the beneficiary.

WEMs are not covered for outpatient monitoring of recently discharged postinfarct patients.

When the billing of these services is split into components, it is expected that the appropriate components of the code series will be billed. 

For 30-day WEM service: 

WEM may be discontinued once the symptom-producing arrhythmia has been documented and diagnosed or following multiple transmissions during symptoms, without arrhythmia. It is unlikely that the arrhythmias would always be diagnosed on the first day of recording or that the service would always last only one day. The average duration of monitoring is anticipated to last 10–14 days or more.

WEM is a 30-day packaged service. Tests may not be billed more than once within 30 days of each other, even if the earlier of the tests was discontinued when arrhythmias were documented and the patient is now reconnected for follow-up of therapy or intervention.

Because the WEM service requires the diagnosis and evaluation of intermittent arrhythmias and patients must be continuously attached to presymptom loop recorders, each patient is required to have a recorder for his/her own exclusive use throughout the duration of the monitoring period. 

The receiving station must be staffed on a 24-hour basis. An answering service/answering machine would not fulfill this requirement.



Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable

Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable




ICD-10 Codes that Support Medical Necessity

ICD-10 CODE DESCRIPTION

G45.1 - G45.2 - Opens in a new window Carotid artery syndrome (hemispheric) - Multiple and bilateral precerebral artery syndromes

G45.8 - G46.2 - Opens in a new window Other transient cerebral ischemic attacks and related syndromes - Posterior cerebral 
artery syndrome

I20.0 - I20.9 - Opens in a new window Unstable angina - Angina pectoris, unspecified

I24.0 - I24.9 - Opens in a new window Acute coronary thrombosis not resulting in myocardial infarction - Acute ischemic 
heart disease, unspecified
I25.110 - I25.2 - Opens in a new window Atherosclerotic heart disease of native coronary artery with unstable angina pectoris 
- Old myocardial infarction

I25.5 - I25.799 - Opens in a new window Ischemic cardiomyopathy - Atherosclerosis of other coronary artery bypass graft(s) 
with unspecified angina pectoris

I25.89 - I25.9 - Opens in a new window Other forms of chronic ischemic heart disease - Chronic ischemic heart disease, 
unspecified

I34.0 - I35.9 - Opens in a new window Nonrheumatic mitral (valve) insufficiency - Nonrheumatic aortic valve disorder, 
unspecified

I42.0 Dilated cardiomyopathy

I42.5 Other restrictive cardiomyopathy

I42.8 - I42.9 - Opens in a new window Other cardiomyopathies - Cardiomyopathy, unspecified

I44.1 - I44.30 - Opens in a new window Atrioventricular block, second degree - Unspecified atrioventricular block

I44.4 - I45.2 - Opens in a new window Left anterior fascicular block - Bifascicular block

I45.5 - I45.9 - Opens in a new window Other specified heart block - Conduction disorder, unspecified
I47.0 - I48.92 - Opens in a new window Re-entry ventricular arrhythmia - Unspecified atrial flutter

I49.02 - I50.9 - Opens in a new window Ventricular flutter - Heart failure, unspecified

I63.40 - I63.49 - Opens in a new window Cerebral infarction due to embolism of unspecified cerebral artery - Cerebral 
infarction due to embolism of other cerebral artery

I66.01 - I66.3 - Opens in a new window Occlusion and stenosis of right middle cerebral artery - Occlusion and stenosis of 
cerebellar arteries

I66.9 Occlusion and stenosis of unspecified cerebral artery

I67.841 - I67.848 - Opens in a new window Reversible cerebrovascular vasoconstriction syndrome - Other cerebrovascular 
vasospasm and vasoconstriction

R00.0 - R00.2 - Opens in a new window Tachycardia, unspecified - Palpitations

R06.00 - R06.01 - Opens in a new window Dyspnea, unspecified - Orthopnea

R06.09 Other forms of dyspnea

R06.89 Other abnormalities of breathing

R07.2 Precordial pain

R07.82 - R07.9 - Opens in a new window Intercostal pain - Chest pain, unspecified

R40.4 Transient alteration of awareness

R42 Dizziness and giddiness

R55 Syncope and collapse

T82.110A - T82.111S - Opens in a new window Breakdown (mechanical) of cardiac electrode, initial encounter - Breakdown 
(mechanical) of cardiac pulse generator (battery), sequela

T82.120A - T82.121S - Opens in a new window Displacement of cardiac electrode, initial encounter - Displacement of 
cardiac pulse generator (battery), sequela


T82.190A - T82.191S - Opens in a new window Other mechanical complication of cardiac electrode, initial encounter - Other 
mechanical complication of cardiac pulse generator (battery), sequela

Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

Z51.81 Encounter for therapeutic drug level monitoring

Z79.02 - Z79.1 - Opens in a new window Long term (current) use of antithrombotics/antiplatelets - Long term (current) use of 
non-steroidal anti-inflammatories (NSAID)

Z79.899 Other long term (current) drug therapy

Z95.0 Presence of cardiac pacemaker

Z95.9 Presence of cardiac and vascular implant and graft, unspecified

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