SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Cardiac Event Detection

A56452

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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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Contractor Information

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General Information

Source Article ID
N/A
Article ID
A56452
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Cardiac Event Detection
Article Type
Billing and Coding
Original Effective Date
10/01/2018
Revision Effective Date
10/01/2023
Revision Ending Date
11/15/2023
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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CMS National Coverage Policy

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Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy L33952 Cardiac Event Detection.

 

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

 

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

 

 

Response To Comments

Number Comment Response
1
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Coding Information

Bill Type Codes

Code Description

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Revenue Codes

Code Description

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CPT/HCPCS Codes

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CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

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Group 1 Codes

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ICD-10-CM Codes that Support Medical Necessity

Group 1

(60 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

These ICD-10-CM codes can be used only with the conditions listed in the Indications and Limitations sections of the local coverage policy L33952 Cardiac Event Detection.

Group 1 Codes
Code Description
G45.9 Transient cerebral ischemic attack, unspecified
I44.1 Atrioventricular block, second degree
I44.2 Atrioventricular block, complete
I44.30 Unspecified atrioventricular block
I45.5 Other specified heart block
I45.6 Pre-excitation syndrome
I45.89 Other specified conduction disorders
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
I47.20 Ventricular tachycardia, unspecified
I47.21 Torsades de pointes
I47.29 Other ventricular tachycardia
I47.9 Paroxysmal tachycardia, unspecified
I48.0 - I48.4 Paroxysmal atrial fibrillation - Atypical atrial flutter
I48.91 Unspecified atrial fibrillation
I48.92 Unspecified atrial flutter
I49.01 Ventricular fibrillation
I49.02 Ventricular flutter
I49.1 - I49.3 Atrial premature depolarization - Ventricular premature depolarization
I49.40 Unspecified premature depolarization
I49.49 Other premature depolarization
I49.5 Sick sinus syndrome
I49.8 Other specified cardiac arrhythmias
I67.841 Reversible cerebrovascular vasoconstriction syndrome
I67.848 Other cerebrovascular vasospasm and vasoconstriction
I67.850 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
I67.858 Other hereditary cerebrovascular disease
R00.0 - R00.2 Tachycardia, unspecified - Palpitations
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.09 Other forms of dyspnea
R06.1 Stridor
R06.2 Wheezing
R06.4 Hyperventilation
R42 Dizziness and giddiness
R55 Syncope and collapse
T46.0X5A Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial 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
T46.1X5S Adverse effect of calcium-channel blockers, sequela
T46.2X5A Adverse effect of other antidysrhythmic drugs, initial encounter
T46.2X5S Adverse effect of other antidysrhythmic drugs, sequela
T46.905A Adverse effect of unspecified agents primarily affecting the cardiovascular system, initial encounter
T46.905S Adverse effect of unspecified agents primarily affecting the cardiovascular system, sequela
T46.995A Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter
T46.995S Adverse effect of other agents primarily affecting the cardiovascular system, sequela
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ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

(14 Codes)
Group 1 Paragraph

Use of any ICD-10-CM code not listed in the "ICD-10-CM Codes that Support Medical Necessity" section of the local coverage policy L33952 Cardiac Event Detection. In addition, the following ICD-10-CM codes are specifically listed as not supporting medical necessity for emphasis, and to avoid any provider errors.

Group 1 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
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
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ICD-10-PCS Codes

Group 1

Group 1 Paragraph

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Group 1 Codes

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Additional ICD-10 Information

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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

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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.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.


Code Description

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Other Coding Information

Group 1

Group 1 Paragraph

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Group 1 Codes

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

Revision History Date Revision History Number Revision History Explanation
10/01/2023 R10

R10

Revision Effective: 10/01/2023

Revision Explanation: During revision 9 ICD-10 code I47.0 was removed in error. This code has been added back to group 1.

10/01/2023 R9

R9

Revision Effective: 10/01/2023

Revision Explanation: Annual ICD-10 update. I47.1 was deleted and I47.11/ I47.19 were added.

12/01/2022 R8

R8

Revision Effective: 12/01/2022

Revision Explanation: Annual review, no changes 

10/01/2022 R7

R7

Revision Effective: 10/01/2022

Revision Explanation: ICd-10 code I47.9 was removed in error during revision 6 and has been added back to group 1 for codes that support medical necessity.

10/01/2022 R6

R6

Revision Effective: 10/01/2022

Revision Explanation: Replaced I47.2 with  I47.20, I47.21. I47.29

11/25/2021 R5

R5

Revision Effective: 11/25/2021

Revision Explanation: Annual review, no changes were made.

10/01/2019 R4

R4

Revision Effective: N/A

Revision Explanation: Annual review, no changes were made.

10/01/2019 R3

R1

Revision Effective:10/01/2019

Revision Explanation: During the annual ICD-10 update code I48.1 and I48.2 were end dated and replaced with codes I48.11, I48.19, I48.20, and I48.21 in group 1.

09/19/2019 R2

R2

Revision Effective: 09/19/2019

Revision Explanation: Correction to title.

09/19/2019 R1

R1

Revision Effective: 09/19/2019

Revision Explanation: Converted article into new Billing and Coding template no other changes made.

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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
L33952 - Cardiac Event Detection
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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Public Versions
Updated On Effective Dates Status
11/29/2023 12/07/2023 - N/A Currently in Effect View
11/07/2023 11/16/2023 - 12/06/2023 Superseded View
10/19/2023 10/01/2023 - 11/15/2023 Superseded You are here
09/08/2023 10/01/2023 - N/A Superseded View
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