Procedure code and description
93224 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional – Average fee payment – $93
93225 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection) – Average fee payment – $27
93226 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report Average fee payment – $38
93227 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional – $27
Holter
The following is a summary of Current Procedural Terminology (procedure ) codes commonly used for various Holter monitoring procedures performed with a Midmark Holter device. This information is provided only as a guide and is not intended to replace any official recommendations or guidelines, and does not constitute a promise or guarantee by Midmark regarding coverage or payment. Always check with the specific payer for the appropriate use of any procedure or ICD-10 codes. Physician fee schedule values listed are based on a national average and are rounded for brevity.
Specific payments vary geographically. Codes and rates are subject to change. It is the responsibility of the provider to determine the correct coding for services provided.
procedure Manual Instructions for Cardiovascular Monitoring Services
• Cardiovascular monitoring services are diagnostic medical procedures using in-person and remote technology to assess cardiovascular rhythm (ECG) data.
• Holter monitors (93224-93227) include up to 48 hours of continuous recording.
Report proper ICD-10-CM diagnosis codes to support the medical necessity for the use a Holter monitor. ICD-10-CM codes and/or ranges are provided below to help with your decision process.
ICD-10-CM Description ICD-10-CM Code/ Range
Abnormalities of breathing R06.00-R06.9
Abnormalities of heart beat R00.0-R00.9
Aneurysm of heart I25.3
Angina pectoris 120.0-120.9
Atrial fibrillation and flutter I48.0-I48.92
Bradycardia, unspecified R00.1
Cardiac arrest I46.2-I46.9
Cardiac murmurs and other cardiac sounds R01.0-R01.2
Chronic ischemic heart disease I25.10-I25.9
Dizziness and giddiness R42
Gangrene, not elsewhere classified I96
Old myocardial infarction I25.2
Other cardiac arrhythmias I49.0-I49.9
Pain in chest R07.1-R07.9
Paroxysmal tachycardia I47.0-I47.9
ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I21.0-I21.4
Subsequent ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial
infarction I22.0-I22.9
Syncope and collapse R55
External Electrocardiographic Recording Services – CPT codes 93224, 93225, 93226, and 93227 Reported with Modifier 52
CPT codes 93224 – 93227 are reported for external electrocardiographic recording services up to 48 hours by continuous rhythm recording and storage. CPT coding guidelines for codes 93224 – 93227 specify that when there are less than 12 hours of continuous recording modifier 52 (Reduced Services) should be used.
When modifier 52 is appended to CPT code 93224, 93225, 93226, or 93227, Oxford does not apply the Time Span Codes Policy for reimbursement of these codes. Instead, Oxford applies the “Reduced Services Policy” which addresses reimbursement for codes appended with modifier 52.
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. *CPT codes for holter monitoring services (CPT codes 93224-93227) are intended for up to 48 hours of continuous recording. For 48 hour monitoring codes (CPT 93224-93227):
a. The documentation in the progress notes must reflect medical necessity for the service.
b. These services may be reported globally with CPT codes 93224. Use the date of physician review as the date of service (DOS).
c. When submitting claims for the recording only (CPT code 93225) or for the analysis with report only (CPT code 93226) use the date the service was performed as the DOS.
d. When submitting claims for physician review and interpretation (CPT code 93227) use the date the service was performed as the DOS.
e. For less than 12 hours continuous recording, modifier -52 (reduced services) should be appended. (2011 Insider’s View p. 181)
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 IDTF 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 IDTF for the professional codes to the billing IDTF. If a letter is not on file, professional services billed by the IDTF 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. 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
- Detecting transient episodes of cardiac dysrhythmia, permitting correlation of these episodes with cardiovascular symptoms.
- Evaluation of the patient with symptoms suggestive of a cardiac dysrhythmia when another cause cannot be established.
- Evaluation of arrhythmias in patients with documented coronary artery disease, including the assessment of the immediate postmyocardial infarction patient.
- Monitoring the effectiveness of antiarrhythmic therapy.
- Syncope and presyncope are covered indications for Holter monitoring and real-time monitoring.
Limitations
- Holter monitoring and real-time monitoring are not covered for the detection of silent ischemia in patients without symptoms suggestive of ischemia. Routine screening in the absence of signs, symptoms, and complaints is not covered under Title XVIII of the Social Security Act, Section 1862(a)(7).
- Holter monitoring and real-time monitoring are not covered for patients with incidental findings of conduction system defects absent a qualifying indication listed above.
- Holter monitoring and real-time monitoring for vague symptoms such as dizziness are not covered in the absence of symptoms or signs that would suggest cardiac origin of the symptoms.
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Note:
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Providers are reminded to refer to the long descriptors of the
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93224©
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Ecg monit/reprt up to 48 hrs
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93225©
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Ecg monit/reprt up to 48 hrs
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93226©
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Ecg monit/reprt up to 48 hrs
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93227©
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Ecg monit/reprt up to 48 hrs
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Medicare Billing Guidelines
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.
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.
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
3. Additionally, the transmitting devices must meet at least the following criteria;
a. They must be capable transmitting EKG Leads I, II or III; and
b. The tracing must be sufficiently comparable to a conventional EKG. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI is only covered if provision is made for such 24-hour attended coverage in the manner described below.
4. 24-hour attended coverage means there must be, at a monitoring site or central data center, an EKG technician or other non-physician, receiving calls and/or EKG data. Tape recording devices do not meet this requirement. Further, such technicians should have immediate 24-hour access to a physician to review transmitted data and make clinical decisions regarding the patient.
5.The technician should also be instructed as to when how to contact available facilities to assist the patient in case of emergencies.
6. Nationally Non-covered Indications
The following indications are non-covered nationally unless otherwise specified below:
a. The time-sampling mode of operation of ambulatory EKG cardiac event monitoring recording.
b. Separate physician services other than those rendered by an IDTF unless rendered by the patient’s attending or consulting physician.
c. Home EKG services without documentation of medical necessity.
d. Emergency EKG services by a portable x-ray supplier without a physician in attendance at the time of the service or immediately thereafter.
e. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI unless provision is made for such 24-hour attended coverage in the manner described in section 4 above.
Coverage Indications, Limitations, and/or Medical Necessity
Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording capabilities of ECG activities of the patient’s heart while the patient is engaged in daily activities. These can include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide information about rhythm disturbances and waveform abnormalities and to note the frequency of their occurrence.
Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias.
Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient’s ambient heart rhythm during a full day’s (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias.
Medical Necessity:
The medical necessity indications listed in this policy must be present in order for these tests to be covered.
Indications for external 48-hour ECG recording include one or more of the following:
Symptoms:
Arrhythmias
Chest pain
Syncope (lightheadedness) or near syncope
Vertigo (dizziness)
Palpitations
Transient ischemic episodes
Dyspnea (shortness of breath)
Evaluation of the response to antiarrhythmic drug therapy.
Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less.
Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.
Other acute and subacute forms of ischemic heart disease.
To detect arrhythmias post ablation procedures.
The use of 0295T, 0296T, 0297T and 0298T, external electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the diagnosis list to monitor for asymptomatic episodes in order to evaluate treatment response. The use of external electrocardiographic event monitors for more than 48 hours up to 21 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope).
Long term 30-day monitoring: Telephonic Transmission of ECG involves 24 hour attended monitoring per 30 day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
Indications for performing a Telephonic Transmission:
Arrhythmias
Chest pain
Syncope (lightheadedness) or near syncope
Vertigo (dizziness)
Palpitations
Transient ischemic episodes
Dyspnea (shortness of breath)
To initiate, revise or discontinue arrhythmia drug therapy.
Evaluation of myocardial infarction (MI) survivors.
Evaluation of acute and subacute forms of ischemic heart disease.
Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.
Home Telemetry – Medicaid Authorization requirements
Outpatient long-term cardiac (Holter) monitoring codes 93224, 93225, 93226, and 93227 will require prior authorization if more than 3 units of any code are reported in one year. Prior authorization will use the following criteria:
** Outpatient long-term cardiac (Holter) monitoring must be ordered by a neurologist
** Member must have had a stroke or TIA with no identifiable cause
** Member should have already had 24 hour monitoring done previously (either with outpatient long-term cardiac monitoring or as inpatient with telemetry)
** Member should not be currently anti-coagulated on Warfarin for any other reason
** Member should not have a known contraindication for Warfarin
** Outpatient long-term cardiac monitoring may only be authorized for the 30-day test
** Data from the test must be reviewed and interpreted by a cardiologis
Electrocardiograph Holter Monitoring Policy Status: Active Effective: 12/01/2012
Please note: All policies are subject to the terms, conditions and limitations of the member’s plan or program
Description
Holter monitors are portable devices that capture 48 hours or more of continuous external electrocardiographic (ECG) recording and storage, and are used to detect atypical heart rhythms.
The services comprising Holter monitoring can be reported by using one Current Procedural Terminology (procedure ®) code for the global service, or they can be reported by using a combination of the professional and technical component codes for:
• recording of the ECG (which includes the hook-up and disconnection)
• scanning analysis with report
• physician review and interpretation
Policy
1. Non-hospital setting:
ECG Holter Monitoring is eligible for reimbursement when billed as a global service which encompasses both the technical and the professional components, or when a combination of the technical and the professional component services are reported. When a participating provider utilizes an outside non-par vendor for some or all of the technical components of this service, the participating provider is responsible for billing the global service (technical and professional components) and reimbursing the subcontracted vendor.
This will avoid increased member financial liability due to your use of an out-of-network provider as well as member abrasion.
2. Hospital Setting:
Hospital-Based Physicians and private physicians are only eligible to be reimbursed for the professional component. The hospital may bill for the technical components.
Coding Holter Monitoring
93224—-external electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation
93225—-recording (includes connection, recording, and disconnection)
93226—-scanning analysis with report
93227—-physician review and interpretation
ICD-10 CODE DESCRIPTION
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
I21.29 ST elevation (STEMI) myocardial infarction involving other sites
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler’s syndrome
I24.8 Other forms of acute ischemic heart disease
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.2 Old myocardial infarction
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented
spasm
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.39 Other atrioventricular block
I44.4 Left anterior fascicular block
I44.5 Left posterior fascicular block
I44.69 Other fascicular block
I44.7 Left bundle-branch block, unspecified
I45.0 Right fascicular block
I45.19 Other right bundle-branch block
I45.2 Bifascicular block
I45.3 Trifascicular block
I45.4 Nonspecific intraventricular block
I45.5 Other specified heart block
I45.6 Pre-excitation syndrome
I45.81 Long QT syndrome
I45.89 Other specified conduction disorders
I47.0 Re-entry ventricular arrhythmia
I47.1 Supraventricular tachycardia
I47.2 Ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 Paroxysmal atrial fibrillation
I48.1 Persistent atrial fibrillation
I48.2 Chronic atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 Atrial premature depolarization
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R06.01 Orthopnea
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R06.2 Wheezing
R06.3 Periodic breathing
R06.4 Hyperventilation
R06.81 Apnea, not elsewhere classified
R06.82 Tachypnea, not elsewhere classified
R06.83 Snoring
R06.89 Other abnormalities of breathing
R07.2 Precordial pain
R07.82 Intercostal pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R29.5 Transient paralysis
R40.4 Transient alteration of awareness
R42 Dizziness and giddiness
R55 Syncope and collapse
Z79.891 Long term (current) use of opiate analgesic
Z79.899 Other long term (current) drug therapy
ICD-9-CM Codes That Support Medical Necessity
345.00–345.01
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Epilepsy and recurrent seizures
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345.10–345.11
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Epilepsy and recurrent seizures (generalized)
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345.2–345.3
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Epilepsy and recurrent seizures (mal status)
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345.40–345.41
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Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures
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345.50–345.51
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Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures
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345.60–345.61
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Infantile spasms
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345.70–345.71
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Epilepsia partialis continua
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345.80–345.81
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Other forms of epilepsy and recurrent seizures
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345.90–345.91
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Epilepsy unspecified
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410.00–410.02
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Acute myocardial infarction
|
410.10–410.12
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Acute myocardial infarction of other anterior wall
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410.20–410.22
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Acute myocardial infarction of inferolateral wall
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410.30–410.32
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Acute myocardial infarction of inferoposterior wall
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410.40–410.42
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Acute myocardial infarction of other inferior wall
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410.50–410.52
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Acute myocardial infarction of other lateral wall
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410.60–410.62
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True posterior wall infarction
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410.70–410.72
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Subendocardial infarction
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410.80–410.82
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Acute myocardial infarction of other specified sites
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410.90–410.92
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Acute myocardial infarction of unspecified site
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411.0–411.1
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Other acute and subacute forms of ischemic heart disease
|
411.81–411.89
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Acute coronary occlusion without myocardial infarction
|
412
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Old myocardial infarction
|
413.0–413.1
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Angina pectoris
|
413.9
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Other and unspecified angina pectoris
|
414.00–414.07
|
Other forms of chronic ischemic heart disease
|
414.10–414.12
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Aneurysm and dissection of heart
|
414.19
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Other aneurysm of heart
|
414.8–414.9
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Other forms of chronic ischemic heart disease
|
422.0
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Acute myocarditis in diseases classified elsewhere (Note: code underlying disease first.)
|
422.90–422.93
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Other and unspecified acute myocarditis
|
422.99
|
Other myocarditis
|
424.0
|
Mitral valve disorders
|
425.0–425.5
|
Cardiomyopathy
|
426.0
|
Atrioventricular block complete
|
426.10–426.13
|
Atrioventricular block, other and unspecified
|
426.2–426.4
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Conduction disorders
|
426.51–426.54
|
Bundle branch block, other and unspecified
|
426.7
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Anomalous atrioventricular excitation
|
426.9
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Conduction disorder, unspecified
|
427.0–427.2
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Cardiac dysrhythmias
|
427.31–427.32
|
Atrial fibrillation and flutter
|
427.41–427.42
|
Ventricular fibrillation and flutter
|
427.5
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Cardiac arrest
|
427.60–427.61
|
Premature beats
|
427.69
|
Other premature beats
|
427.81
|
Sinoatrial node dysfunction
|
427.89
|
Other specified cardiac dysrhythmias
|
427.9
|
Cardiac dysrhythmia unspecified
|
428.0–428.1
|
Heart failure
|
428.20–428.23
|
Systolic heart failure
|
428.30–428.33
|
Diastolic heart failure
|
428.40–428.43
|
Combined systolic and diastolic heart failure
|
428.9
|
Heart failure unspecified
|
429.0
|
Myocarditis, unspecified
|
429.4
|
Functional disturbances following cardiac surgery
|
429.83
|
Takotsubo syndrome
|
434.10–434.11
|
Cerebral embolism
|
435.8–435.9
|
Transient cerebral ischemia
|
674.50–674.54
|
Peripartum cardiomyopathy
|
780.2
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Syncope and collapse
|
780.31–780.32
|
Convulsions
|
780.39
|
Other convulsions
|
780.4
|
Dizziness and giddiness
|
785.0–785.1
|
Symptoms involving cardiovascular system
|
786.00–786.09
|
Symptoms involving respiratory system and other chest symptoms
|
786.50–786.52
|
Chest pain
|
786.59
|
Other chest pain
|
794.30–794.31
|
Cardiovascular (abnormal)
|
794.39
|
Other nonspecific abnormal function study of cardiovascular system
|
996.01–996.04
|
Mechanical complication of cardiac device, implant and graft
|
996.09
|
Other mechanical complication of cardiac device implant and graft
|
996.72
|
Other complications due to other cardiac device implant and graft
|
V12.53
|
Personal history of sudden cardiac arrest
|
V45.01
|
Cardiac pacemaker in situ
|
V45.02
|
Automatic implantable cardiac defibrillator in situ
|
V45.09
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Other specified cardiac device in situ
|
V58.69
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Long-term (current) use of other medications
|
V67.51
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Follow-up examination following completed treatment with high-risk medication not elsewhere classified
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Cardiac arrhythmias are abnormal heart rhythms. Although some patients with arrhythmias may experience palpitations, weakness, dizziness or fainting, other patients may have no symptoms at all. Effective treatment requires an accurate diagnosis. This can be difficult since arrhythmias can occur infrequently and unpredictably and may be asymptomatic (ECRI, 2014). The type and duration of ambulatory electrocardiography (ECG) monitoring is dictated by the frequency of symptoms.
• Holter monitors are portable devices that record heart rhythms continuously for up to 48 hours. These devices are used to record events that occur at least once a day.
• Non-implantable cardiac event monitors are portable devices that record heart rhythms intermittently for up to 30 days.
These devices capture ECG data before, during and after the time of activation.
• Standard loop recorders have just a few minutes of memory. Newer, more sophisticated devices have extended memory features that can store up to several hours of ECG data.
Recording can be patient-activated when symptoms occur or automatically triggered based on a computer algorithm designed to detect arrhythmias. These devices are used to record infrequent or irregular events.
- Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
- A formal report for every study must be generated that indicates the reason(s) for the test and includes the electrocardiographic interpretation.
- An appropriate medical evaluation of the patient prior to the test must be documented in the patient’s record by the referring physician. This should include a history and physical examination that is of sufficient scope and detail to support medical necessity for the test.
- To verify the necessity and reasonableness of the test, the performing physician should, at minimum, document the diagnostic impression of the referring physician and indicate the patient’s relevant signs, symptoms or pertinent history in his records. The simple statement of certain non-specific test indications (such as chest pain or palpitations, etc.) is unacceptable medical necessity documentation.