Local Coverage Article Billing and Coding

Billing and Coding: Real-Time, Outpatient Cardiac Telemetry

A52995

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Contractor Information

Article Information

General Information

Article ID
A52995
Article Title
Billing and Coding: Real-Time, Outpatient Cardiac Telemetry
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2019
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2020 American Dental Association. All rights reserved.

Copyright © 2013 - 2021, the American Hospital Association, Chicago, Illinois. Reproduced by CMS with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312-893-6816. Making copies or utilizing the content of the UB-04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. To license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You may also contact us at ub04@aha.org.

CMS National Coverage Policy

Please refer to the related Local Coverage Determination (LCD) L34997, Real-Time, Outpatient Cardiac Telemetry

Article Guidance

Article Text

Please refer to the Novitas Local Coverage Determination (LCD) L34997, Real-Time, Outpatient Cardiac Telemetry for reasonable and necessary requirements and frequency limitations.

The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

Procedure codes 93228 and 93229 are reported once per 30 day monitoring period. The date of service is reported on the claim as the date the monitoring period is initiated (i.e., the date the patient is first placed on the monitor).

Technical services (93229) that are transferred from one receiving center to another during the same monitoring period must be reported with the modifier -52. Each entity that provided a portion of the technical portion must report 93229 with the -52 modifier and indicate in the claim narrative the percentage of the total service provided.

Claims for outpatient cardiac telemetry (wearable mobile cardiovascular telemetry) with concurrent real-time data analysis and NOT greater than 24 hours of accessible ECG storage, such as the eCardio eVolution monitor, should not be billed under these codes.

Coding Information

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
93228 Remote 30 day ecg rev/report
93229 Remote 30 day ecg tech supp

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

Group 1 Codes
CodeDescription
G45.9 Transient cerebral ischemic attack, unspecified
I44.0 Atrioventricular block, first degree
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.30 Unspecified atrioventricular block
I45.6 Pre-excitation 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
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.3 Typical atrial flutter
I48.4 Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.2 Junctional premature depolarization
I49.5 Sick sinus syndrome
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
R00.0 Tachycardia, unspecified
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R42 Dizziness and giddiness
R55 Syncope and collapse
Z79.01* Long term (current) use of anticoagulants
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

Notation: Report Z79.01 in conjunction with I48.0, I48.20, I48.21 or I48.91 to indicate monitoring to determine appropriateness of anticoagulation therapy discontinuation.

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All those not listed under the "ICD-10 Codes that Support Medical Necessity" section of this policy.

Group 1 Codes
CodeDescription
XX000 Not Applicable

Additional ICD-10 Information

N/A

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 article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

CodeDescription
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 article, 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 article should be assumed to apply equally to all Revenue Codes.

CodeDescription
99999 Not Applicable

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2019 R1

LCD revised and published on 10/17/2019 effective for dates of service on or after 10/01/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. The statement regarding monitoring services such as eCardio eVolution has been removed from the LCD and placed in the article. Standard language has been added throughout the article. In response to the Annual ICD-10-CM update, the following ICD-10-CM codes have been deleted and therefore have been removed from the article: I48.1 and I48.2. The following ICD-10-CM codes have been added to the article: I48.11, I48.19, I48.20 and I48.21 and the asterisk explanation has been updated. Due to system changes, the Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

Associated Documents

Related Local Coverage Documents
LCDs
L34997 - Real-Time, Outpatient Cardiac Telemetry
Related National Coverage Documents
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
10/11/2019 10/01/2019 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A