RETIRED LCD Reference Article Billing and Coding Article

Billing and Coding: Long-Term Wearable Electrocardiographic Monitoring (WEM)

A57062

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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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General Information

Source Article ID
N/A
Article ID
A57062
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Long-Term Wearable Electrocardiographic Monitoring (WEM)
Article Type
Billing and Coding
Original Effective Date
10/03/2018
Revision Effective Date
10/01/2022
Revision Ending Date
06/11/2023
Retirement Date
06/11/2023
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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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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) L33380 Long-Term Wearable Electrocardiographic Monitoring. 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.

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.
  4. Medical record documentation maintained by the ordering/referring physician must clearly indicate the medical necessity of Holter monitor studies. Also, the results of Holter studies must be included in the patient's medical record.
  5. If the provider of Holter studies is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation along with copies of the ordering/referring physician's order for the study. When ordering Holter studies from an independent physiological lab or other provider, the ordering/referring physician must state the reason for the Holter study in his order for the test.
  6. Medical record documentation maintained by the ordering/referring physician/nonphysician practitioner (e.g., complete history and physical, 12 lead EKG, and rhythm strip performed prior to initiation of the patient demand event recorder) must indicate the medical necessity for use of the patient demand single or multiple event recorder. If ICD-10-CM code R00.2 (Palpitations) is the diagnosis billed, the history and physical or other pertinent medical record documentation must support the presence of associated symptoms such as dizziness, shortness of breath, chest discomfort, or an underlying history of cardiac disease. The medical record should support that specific symptoms (syncope, dizziness, chest pain, palpitations, or shortness of breath) may correlate with intermittent cardiac arrhythmias and/or myocardial ischemia.
  7. If the provider of the service is other than the ordering/referring physician/nonphysician practitioner, the order must state the indication/medical necessity for the patient demand event recorder, and the provider of the service is responsible for ensuring that all of the necessary coverage criteria have been met prior to the initiation of the patient demand event recorder.
  8. The EKG rhythm strip transmission and interpretation must include the following information: the name of the patient, the presenting diagnosis, the time and date of the transmission, the lead of the EKG transmission, the PR interval, the QRS interval, the rate, the rhythm, the signature of the person interpreting the EKG strip, cardiovascular symptomatology reported by the patient at the time of the transmission, any necessary actions (e.g., notification of physician, emergency instructions given to patient, etc.) taken by the person interpreting the EKG rhythm strip.
  9. For external electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage (CPT codes 93241-93248), the documentation must clearly support for each individual patient the medical necessity for the use of external electrocardiographic recording for more than 48 hours up to 21 days. The record should clearly outline the indication (diagnostic criteria) and its medical need. 

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
999x Not Applicable
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

(14 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
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
93241 Ext ecg>48hr<7d rec scan a/r
93242 Ext ecg>48hr<7d recording
93243 Ext ecg>48hr<7d scan a/r
93244 Ext ecg>48hr<7d rev&interpj
93245 Ext ecg>7d<15d rec scan a/r
93246 Ext ecg>7d<15d recording
93247 Ext ecg>7d<15d scan a/r
93248 Ext ecg>7d<15d rev&interpj

Group 2

(4 Codes)
Group 2 Paragraph

N/A

Group 2 Codes
Code Description
93268 Ecg record/review
93270 Remote 30 day ecg rev/report
93271 Ecg/monitoring and analysis
93272 Ecg/review interpret only
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

(161 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: 93224, 93225, 93226, 93227, 93228, 93229, 93241, 93242, 93243, 93244, 93245, 93246, 93247, and 93248.

Group 1 Codes
Code Description
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I20.9 Angina pectoris, unspecified
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
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
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
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I24.1 Dressler's syndrome
I24.8 Other forms of acute ischemic heart disease
I24.9 Acute ischemic heart disease, unspecified
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
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
I25.112 Atherosclerosic heart disease of native coronary artery with refractory angina pectoris
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
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
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified 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
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified 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
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified 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
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified 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
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified 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
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified 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
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I31.0 Chronic adhesive pericarditis
I31.1 Chronic constrictive pericarditis
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
I34.2 Nonrheumatic mitral (valve) stenosis
I34.81 Nonrheumatic mitral (valve) annulus calcification
I34.89 Other nonrheumatic mitral valve disorders
I34.9 Nonrheumatic mitral valve disorder, unspecified
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
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
I45.0 Right fascicular block
I45.10 Unspecified right bundle-branch block
I45.19 Other right bundle-branch block
I45.2 Bifascicular block
I45.6 Pre-excitation syndrome
I45.81 Long QT 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
I47.1 Supraventricular tachycardia
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
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
I49.1 Atrial premature depolarization
I49.2 Junctional premature depolarization
I49.3 Ventricular premature depolarization
I49.49 Other premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
I49.9 Cardiac arrhythmia, unspecified
I51.7 Cardiomegaly
I51.9 Heart disease, unspecified
I52 Other heart disorders in diseases classified elsewhere
I97.0 Postcardiotomy syndrome
I97.110 Postprocedural cardiac insufficiency following cardiac surgery
I97.111 Postprocedural cardiac insufficiency following other surgery
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.130 Postprocedural heart failure following cardiac surgery
I97.131 Postprocedural heart failure following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R55 Syncope and collapse
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5D Adverse effect of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5D Adverse effect of calcium-channel blockers, subsequent encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5D Adverse effect of other antidysrhythmic drugs, subsequent encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
Z09 Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm
Z95.0 Presence of cardiac pacemaker
Z95.810 Presence of automatic (implantable) cardiac defibrillator
Z95.818 Presence of other cardiac implants and grafts
Z95.9 Presence of cardiac and vascular implant and graft, unspecified

Group 2

(22 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: 93268, 93270, 93271, and 93272.

Group 2 Codes
Code Description
I49.9 Cardiac arrhythmia, unspecified
R00.2 Palpitations
R06.00 Dyspnea, unspecified
R06.03 Acute respiratory distress
R06.09 Other forms of dyspnea
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
R42 Dizziness and giddiness
R55 Syncope and collapse
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter
T46.0X5D Adverse effect of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter
T46.0X5S Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela
T46.1X5A Adverse effect of calcium-channel blockers, initial encounter
T46.1X5D Adverse effect of calcium-channel blockers, subsequent encounter
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5D Adverse effect of other antidysrhythmic drugs, subsequent encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
N/A

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

Group 1

Group 1 Paragraph

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

Group 1 Codes

N/A

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
999x Not Applicable
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.

Code Description
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
06/11/2023 R3

This article is being retired effective for dates of service on and after 06/11/2023. Please refer to LCA, A59270 - Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring.

10/01/2022 R2

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: I25.112, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792, I34.81, I34.89, I47.21, and I47.29 to the ICD-10-CM Codes that Support Medical Necessity ‘Group 1 Codes’. The following ICD-10-CM codes have been deleted and therefore have been removed from the article: I34.8 and I47.2 from the ICD-10-CM Codes that Support Medical Necessity ‘Group 1 Codes’. Formatting changes have been made throughout the article.

01/01/2021 R1

Article revised and published on 02/11/2021 effective for dates of service on and after 01/01/2021 to reflect the Annual 2021 HCPCS/CPT Code Updates to add CPT codes 932141, 93242, 93243, 93244, 93245, 93246, 93247, and 93248, to delete CPT codes 0295T, 0296T, 0297T, and 0298T. CPT/HCPCS code: Group 1 Codes and the ICD-10 Codes that Support Medical Necessity/Group 1 Codes: sections. Minor formatting changes were made throughout the article.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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