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CPT code and Descriptions
93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional
93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional
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
Billing Guidelines
External Mobile Cardiac Telemetry Monitors
As of 01/01/2009, CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Because of this, wearable mobile cardiovascular telemetry services should no longer be reported using 93799 Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring
*As of 01/01/2011, the term wearable mobile cardiovascular telemetry services, is changed to external mobile cardiovascular telemetry services.
*As of 01/01/2011, do not report CPT code 93228 with CPT codes 93224 and 93227.
*As of 01/01/2011, do not report CPT code 93229 with CPT codes 93224 and 93226.
For dates of service prior to 01/01/2009, claims for outpatient mobile cardiovascular telemetry should be submitted using CPT code 93799 (unlisted cardiovascular service procedure).
CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:
a. Patient hook-up and patient-specific instruction and education
b. Transmission and receipt of ECG
c. Analysis of ECG by nonphysician personnel
d. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoringepisode
e. Equipment maintenance.
f. All supplies necessary for completion of the monitoring
CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.
The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:
a. The date of service must be reported as the date the patient was initially placed on the monitor.
b. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
c. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.
GY and GZ Modifiers
When billing for services, requested by the beneficiary for denial, that are statutorily excluded by Medicare (i.e. screening), report a screening ICD-9 code and the GY modifier (items or services statutorily excluded or does not meet the definition of any Medicare benefit) When billing for services, requested by the beneficiary for denial, that would be considered not reasonable and necessary, report an ICD-9 code that best describes the patients condition and the GA modifier if an ABN signed by the beneficiary is on file or the GZ modifier (items or services expected to be denied as not reasonable) when there is no ABN for the service on file.
Coding Guidelines
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare
1. List the appropriate procedure code.
a. If billing for 48 hours for codes 93224-93227, indicate this by placing each date of service on a separate line with a 1 in the unit's box (e.g., 010).
b. The documentation in the progress notes must reflect medical necessity for the service.
2. List the ICD-9 code(s) indicating the reason for the test.
3. The name and NPI number of the referring/ordering physician or qualified non-physician practitioner must be reported in boxes 17 and 17a of CMS-1500 form or in the EAO record fields 20.0 (for NPI number) and 22.0 (name) when submitting electronically.
4. The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K. For EMC, use NSF format field FA0 - 23, or ANSI - 837 or NM1 - 09 (loop 2310).
5. The codes describing technical work may be billed by an independent diagnostic testing facility (IDTF) if they meet all requirements listed in the code descriptions and coverage requirements. They may bill the total component only if the physician interpreting the test is employed or contracted by the laboratory and is not billing for the interpretation separately. The physician's name and address must be on record with our WPS Provider Enrollment Department. A letter should be sent by the physician assigning all monies collected by the laboratory for the professional codes to the billing laboratory. If a letter is not on file, professional services billed by the IDTF laboratories will be denied.
6. Do not use the "TC" or "26" modifier with the codes 93224-93229, 93268, 93270, 93271, or 93272, listed in the CPT/HCPCS section of the LCD.
7. For the same dates of service, either the wearable patient monitor or the up to 48-hour monitor will be covered (not both).
8. Wearable Mobile Cardiovascular
As of 01/01/2009, CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Because of this, wearable mobile cardiovascular telemetry services should no longer be reported using 93799 Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring
For dates of service prior to 01/01/2009, claims for outpatient mobile cardiovascular telemetry should be submitted using CPT code 93799 (unlisted cardiovascular service procedure).
CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:
a. Patient hook-up and patient-specific instruction and education
b. Transmission and receipt of ECG
c. Analysis of ECG by nonphysician personnel
d. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
e. Equipment maintenance.
f. All supplies necessary for completion of the monitoring
CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.
The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:
a. The date of service must be reported as the date the patient was initially placed on the monitor.
b. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
c. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.
B. Types of monitoring and coverage:
1. Continuous up to 48-hour Monitoring (CPT codes 93224-93227), includes a coverage period of up to 48-hours for one unit of service. No other EKG monitoring codes can be billed simultaneously with these codes.
2. CPT codes 93268-93272
Cardiac event monitor technology varies among different devices. For patient-activated event monitors, the patient initiates recording when symptoms appear or when instructed to do so by a physician (e.g., following exercise). For self-sensing automatically triggered monitors, an EKG is automatically recorded when the device detects an arrhythmia, without patient intervention. Some devices permit a patient to transmit EKG data trans-telephonically (i.e., via telephone) to a receiving center where the data is reviewed. A technician may be available at these centers to review transmitted data 24- hours per day. In some instances, when the EKG is determined to be outside certain preset criteria by a technician or other non-physician, a physician is available 24 hours per day to review the transmitted data and make clinical decisions regarding the patient.
These services are known as 24 hour "attended monitoring". In other instances, transmitted EKG data is reviewed at a later time and are, therefore, considered "nonattended."
.
a. The person receiving the transmission must be a technician, nurse, or a physician trained in interpreting ECG's and abnormal rhythms.
b. A physician must be available 24 hours a day for immediate consultation to review the transmission in case of significant symptoms or ECG abnormalities
93228 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional
93229 External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and physician prescribed transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional
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.
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
Billing Guidelines
External Mobile Cardiac Telemetry Monitors
As of 01/01/2009, CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Because of this, wearable mobile cardiovascular telemetry services should no longer be reported using 93799 Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring
*As of 01/01/2011, the term wearable mobile cardiovascular telemetry services, is changed to external mobile cardiovascular telemetry services.
*As of 01/01/2011, do not report CPT code 93228 with CPT codes 93224 and 93227.
*As of 01/01/2011, do not report CPT code 93229 with CPT codes 93224 and 93226.
For dates of service prior to 01/01/2009, claims for outpatient mobile cardiovascular telemetry should be submitted using CPT code 93799 (unlisted cardiovascular service procedure).
CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:
a. Patient hook-up and patient-specific instruction and education
b. Transmission and receipt of ECG
c. Analysis of ECG by nonphysician personnel
d. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoringepisode
e. Equipment maintenance.
f. All supplies necessary for completion of the monitoring
CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.
The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:
a. The date of service must be reported as the date the patient was initially placed on the monitor.
b. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
c. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.
GY and GZ Modifiers
When billing for services, requested by the beneficiary for denial, that are statutorily excluded by Medicare (i.e. screening), report a screening ICD-9 code and the GY modifier (items or services statutorily excluded or does not meet the definition of any Medicare benefit) When billing for services, requested by the beneficiary for denial, that would be considered not reasonable and necessary, report an ICD-9 code that best describes the patients condition and the GA modifier if an ABN signed by the beneficiary is on file or the GZ modifier (items or services expected to be denied as not reasonable) when there is no ABN for the service on file.
Coding Guidelines
The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare
1. List the appropriate procedure code.
a. If billing for 48 hours for codes 93224-93227, indicate this by placing each date of service on a separate line with a 1 in the unit's box (e.g., 010).
b. The documentation in the progress notes must reflect medical necessity for the service.
2. List the ICD-9 code(s) indicating the reason for the test.
3. The name and NPI number of the referring/ordering physician or qualified non-physician practitioner must be reported in boxes 17 and 17a of CMS-1500 form or in the EAO record fields 20.0 (for NPI number) and 22.0 (name) when submitting electronically.
4. The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K. For EMC, use NSF format field FA0 - 23, or ANSI - 837 or NM1 - 09 (loop 2310).
5. The codes describing technical work may be billed by an independent diagnostic testing facility (IDTF) if they meet all requirements listed in the code descriptions and coverage requirements. They may bill the total component only if the physician interpreting the test is employed or contracted by the laboratory and is not billing for the interpretation separately. The physician's name and address must be on record with our WPS Provider Enrollment Department. A letter should be sent by the physician assigning all monies collected by the laboratory for the professional codes to the billing laboratory. If a letter is not on file, professional services billed by the IDTF laboratories will be denied.
6. Do not use the "TC" or "26" modifier with the codes 93224-93229, 93268, 93270, 93271, or 93272, listed in the CPT/HCPCS section of the LCD.
7. For the same dates of service, either the wearable patient monitor or the up to 48-hour monitor will be covered (not both).
8. Wearable Mobile Cardiovascular
As of 01/01/2009, CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Because of this, wearable mobile cardiovascular telemetry services should no longer be reported using 93799 Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring
For dates of service prior to 01/01/2009, claims for outpatient mobile cardiovascular telemetry should be submitted using CPT code 93799 (unlisted cardiovascular service procedure).
CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:
a. Patient hook-up and patient-specific instruction and education
b. Transmission and receipt of ECG
c. Analysis of ECG by nonphysician personnel
d. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
e. Equipment maintenance.
f. All supplies necessary for completion of the monitoring
CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.
The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:
a. The date of service must be reported as the date the patient was initially placed on the monitor.
b. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.
c. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.
B. Types of monitoring and coverage:
1. Continuous up to 48-hour Monitoring (CPT codes 93224-93227), includes a coverage period of up to 48-hours for one unit of service. No other EKG monitoring codes can be billed simultaneously with these codes.
2. CPT codes 93268-93272
Cardiac event monitor technology varies among different devices. For patient-activated event monitors, the patient initiates recording when symptoms appear or when instructed to do so by a physician (e.g., following exercise). For self-sensing automatically triggered monitors, an EKG is automatically recorded when the device detects an arrhythmia, without patient intervention. Some devices permit a patient to transmit EKG data trans-telephonically (i.e., via telephone) to a receiving center where the data is reviewed. A technician may be available at these centers to review transmitted data 24- hours per day. In some instances, when the EKG is determined to be outside certain preset criteria by a technician or other non-physician, a physician is available 24 hours per day to review the transmitted data and make clinical decisions regarding the patient.
These services are known as 24 hour "attended monitoring". In other instances, transmitted EKG data is reviewed at a later time and are, therefore, considered "nonattended."
.
a. The person receiving the transmission must be a technician, nurse, or a physician trained in interpreting ECG's and abnormal rhythms.
b. A physician must be available 24 hours a day for immediate consultation to review the transmission in case of significant symptoms or ECG abnormalities
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
References:
[2]. APR53901-EN-R1_Holter-Reimbursement-Sheet_Sell-Sheet-LR.pdf (hillrom.com)
http://www.cms1500claimbilling.com/2017/03/cpt-93224-93225-93228-93229-ecg.html