LCD Reference Article Billing and Coding Article

Billing and Coding: Cardiac Rhythm Device Evaluation

A56602

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

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General Information

Source Article ID
N/A
Article ID
A56602
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Cardiac Rhythm Device Evaluation
Article Type
Billing and Coding
Original Effective Date
06/13/2019
Revision Effective Date
10/01/2023
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 2023 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.

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Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced 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. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L34833, Cardiac Rhythm Device Evaluation. Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice
: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

CPT code 93292 should be reported when billing Medicare Part B for the analysis of a Wearable Defibrillator System.

CPT Codes 93260, 93261, 93279-93292 are reported per procedure.

Utilization Parameters

CPT Codes 93293, 93294, 93295 and 93296 are reported no more than once every 90 days.

Do not report CPT codes 93293, 93294, 93295 and 93296, if the monitoring period is less than 30 days.

Documentation Requirements

  1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
  2. Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.
  3. The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
071x Clinic - Rural Health
073x Clinic - Freestanding
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
048X Cardiology - General Classification
073X EKG/ECG (Electrocardiogram) - General Classification
0920 Other Diagnostic Services - General Classification
0981 Professional Fees - Emergency Room Services
N/A

CPT/HCPCS Codes

Group 1

(18 Codes)
Group 1 Paragraph

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

Group 1 Codes
Code Description
93260 Prgrmg dev eval impltbl sys
93261 Interrogate subq defib
93279 Prgrmg dev eval pm/ldls pm
93280 Pm device progr eval dual
93281 Pm device progr eval multi
93282 Prgrmg eval implantable dfb
93283 Prgrmg eval implantable dfb
93284 Prgrmg eval implantable dfb
93286 Peri-px eval pm/ldls pm ip
93287 Peri-px device eval & prgr
93288 Interrog evl pm/ldls pm ip
93289 Interrog device eval heart
93292 Wcd device interrogate
93293 Pm phone r-strip device eval
93294 Rem interrog evl pm/ldls pm
93295 Dev interrog remote 1/2/mlt
93296 Rem interrog evl pm/ids
93724 Analyze pacemaker system
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(126 Codes)
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.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93279, 93280, 93281, 93286, 93288, 93293, 93294, 93296 and 93724.

Group 1 Codes
Code Description
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.4 Left anterior fascicular block
I44.5 Left posterior fascicular block
I44.60 Unspecified fascicular block
I44.69 Other fascicular block
I44.7 Left bundle-branch block, unspecified
I45.0 Right fascicular block
I45.10 Unspecified right bundle-branch block
I45.19 Other right bundle-branch block
I45.2 Bifascicular block
I45.3 Trifascicular block
I45.6 Pre-excitation syndrome
I45.9 Conduction disorder, unspecified
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I47.0 Re-entry ventricular arrhythmia
I47.11 Inappropriate sinus tachycardia, so stated
I47.19 Other supraventricular tachycardia
I47.21 Torsades de pointes
I47.29 Other 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
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.2 Junctional premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R55 Syncope and collapse
T82.110A - T82.110S Breakdown (mechanical) of cardiac electrode, initial encounter - Breakdown (mechanical) of cardiac electrode, sequela
T82.111A - T82.111S Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter - Breakdown (mechanical) of cardiac pulse generator (battery), sequela
T82.118A - T82.118S Breakdown (mechanical) of other cardiac electronic device, initial encounter - Breakdown (mechanical) of other cardiac electronic device, sequela
T82.119A - T82.119S Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter - Breakdown (mechanical) of unspecified cardiac electronic device, sequela
T82.120A - T82.120S Displacement of cardiac electrode, initial encounter - Displacement of cardiac electrode, sequela
T82.121A - T82.121S Displacement of cardiac pulse generator (battery), initial encounter - Displacement of cardiac pulse generator (battery), sequela
T82.128A - T82.128S Displacement of other cardiac electronic device, initial encounter - Displacement of other cardiac electronic device, sequela
T82.129A - T82.129S Displacement of unspecified cardiac electronic device, initial encounter - Displacement of unspecified cardiac electronic device, sequela
T82.190A - T82.190S Other mechanical complication of cardiac electrode, initial encounter - Other mechanical complication of cardiac electrode, sequela
T82.191A - T82.191S Other mechanical complication of cardiac pulse generator (battery), initial encounter - Other mechanical complication of cardiac pulse generator (battery), sequela
T82.198A - T82.198S Other mechanical complication of other cardiac electronic device, initial encounter - Other mechanical complication of other cardiac electronic device, sequela
T82.199A - T82.199S Other mechanical complication of unspecified cardiac device, initial encounter - Other mechanical complication of unspecified cardiac device, sequela
T82.221A Breakdown (mechanical) of biological heart valve graft, initial encounter
T82.222A Displacement of biological heart valve graft, initial encounter
T82.223A Leakage of biological heart valve graft, initial encounter
T82.228A Other mechanical complication of biological heart valve graft, initial encounter
T82.512A Breakdown (mechanical) of artificial heart, initial encounter
T82.514A Breakdown (mechanical) of infusion catheter, initial encounter
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.522A Displacement of artificial heart, initial encounter
T82.524A Displacement of infusion catheter, initial encounter
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.529A Displacement of unspecified cardiac and vascular devices and implants, initial encounter
T82.532A Leakage of artificial heart, initial encounter
T82.534A Leakage of infusion catheter, initial encounter
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.592A Other mechanical complication of artificial heart, initial encounter
T82.594A Other mechanical complication of infusion catheter, initial encounter
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial encounter
T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial encounter
T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial encounter
T82.9XXA Unspecified complication of cardiac and vascular prosthetic device, implant and graft, initial encounter
Z45.010 Encounter for checking and testing of cardiac pacemaker pulse generator [battery]
Z45.018 Encounter for adjustment and management of other part of cardiac pacemaker
Z45.09 Encounter for adjustment and management of other cardiac device
Z86.74 Personal history of sudden cardiac arrest
Z95.0 Presence of cardiac pacemaker
Z95.818 Presence of other cardiac implants and grafts
Z95.9 Presence of cardiac and vascular implant and graft, unspecified

Group 2

(68 Codes)
Group 2 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.

The following ICD-10-CM codes support medical necessity and provide coverage for CPT codes: 93260, 93261, 93282, 93283, 93284, 93287, 93289, 93292, 93295 and 93296. All diagnoses listed under Pacemakers may apply to these codes, as well.

Group 2 Codes
Code Description
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
I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
I21.4 Non-ST elevation (NSTEMI) myocardial infarction
I21.9 Acute myocardial infarction, unspecified
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
I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.2 Old myocardial infarction
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I42.0 Dilated cardiomyopathy
I45.81 Long QT syndrome
I49.3 Ventricular premature depolarization
I49.9 Cardiac arrhythmia, unspecified
R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation
R93.89 Abnormal findings on diagnostic imaging of other specified body structures
T82.110A - T82.110S Breakdown (mechanical) of cardiac electrode, initial encounter - Breakdown (mechanical) of cardiac electrode, sequela
T82.111A - T82.111S Breakdown (mechanical) of cardiac pulse generator (battery), initial encounter - Breakdown (mechanical) of cardiac pulse generator (battery), sequela
T82.118A - T82.118S Breakdown (mechanical) of other cardiac electronic device, initial encounter - Breakdown (mechanical) of other cardiac electronic device, sequela
T82.119A - T82.119S Breakdown (mechanical) of unspecified cardiac electronic device, initial encounter - Breakdown (mechanical) of unspecified cardiac electronic device, sequela
T82.120A - T82.120S Displacement of cardiac electrode, initial encounter - Displacement of cardiac electrode, sequela
T82.121A - T82.121S Displacement of cardiac pulse generator (battery), initial encounter - Displacement of cardiac pulse generator (battery), sequela
T82.128A - T82.128S Displacement of other cardiac electronic device, initial encounter - Displacement of other cardiac electronic device, sequela
T82.129A - T82.129S Displacement of unspecified cardiac electronic device, initial encounter - Displacement of unspecified cardiac electronic device, sequela
T82.190A - T82.190S Other mechanical complication of cardiac electrode, initial encounter - Other mechanical complication of cardiac electrode, sequela
T82.191A - T82.191S Other mechanical complication of cardiac pulse generator (battery), initial encounter - Other mechanical complication of cardiac pulse generator (battery), sequela
T82.198A - T82.198S Other mechanical complication of other cardiac electronic device, initial encounter - Other mechanical complication of other cardiac electronic device, sequela
T82.199A - T82.199S Other mechanical complication of unspecified cardiac device, initial encounter - Other mechanical complication of unspecified cardiac device, sequela
Z45.02 Encounter for adjustment and management of automatic implantable cardiac defibrillator
Z95.810* Presence of automatic (implantable) cardiac defibrillator
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*Report ICD-10-CM code Z95.810 only when the service is a scheduled monitoring of the device.

N/A

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

Group 1

(1 Code)
Group 1 Paragraph

All those not listed under the “ICD-10-CM Codes that Support Medical Necessity” section of this article.

Group 1 Codes
Code Description
XX000 Not Applicable
N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

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.

Code Description
011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
021x Skilled Nursing - Inpatient (Including Medicare Part A)
071x Clinic - Rural Health
073x Clinic - Freestanding
083x Ambulatory Surgery Center
085x Critical Access Hospital
N/A

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.

Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Medicare Claims Processing Manual, for further guidance.


Code Description
048X Cardiology - General Classification
073X EKG/ECG (Electrocardiogram) - General Classification
0920 Other Diagnostic Services - General Classification
0981 Professional Fees - Emergency Room Services
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R4

Article revised and published on 10/26/2023 effective for dates of service on and after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM code has been deleted and therefore has been removed from the article: I47.1 in Group 1 Codes. The following ICD-10-CM codes have been added to the article: I47.11 and I47.19 in Group 1 Codes. Minor formatting changes have been made throughout the article.

10/01/2022 R3

Article revised and published on 10/20/2022 effective for dates of service on and after 10/01/2022 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10-CM codes have been added to the Article: I47.21 and I47.29 to ‘Group 1 Codes’ and the following ICD-10-CM code has been deleted and therefore has been removed from the article: I47.2 from ‘Group 1 Codes’. In addition, the reference to the Social Security Act has been added to the ‘CMS National Coverage Policy’ and Documentation requirements have also been added along with formatting changes throughout the article.  

01/01/2020 R2

Article revised and published on 01/16/2020 effective for dates of service on and after 01/01/2020 to reflect the annual CPT/HCPCS code updates. The following CPT/HCPCS code has been deleted: 93299. The statements referencing 93264 and 93297 - 93299 have been removed from the article text. Reference to these codes in this article was a clerical error. The codes are not addressed in this article.

10/01/2019 R1

Article revised and published on 10/17/2019 effective for dates of service on and after 10/01/2019 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10 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 Group 1 ICD-10 codes of the Article: I48.11, I48.19, I48.20 and I48.21. Please note: System changes have been made to our articles in response to CMS Change Request 10901. The Coding Section has been reordered and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34833 - Cardiac Rhythm Device Evaluation
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Updated On Effective Dates Status
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