LCD Reference Article Billing and Coding Article

Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring

A59268

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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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Source Article ID
N/A
Article ID
A59268
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring
Article Type
Billing and Coding
Original Effective Date
06/11/2023
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
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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.

Medicare National Correct Coding Initiative (NCCI) Policy Manual:

  • Chapter 1, Section E Modifiers and Modifier Indicators and Section V Medically Unlikely Edits (MUEs).

Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L39490, Ambulatory Electrocardiograph (AECG) Monitoring. Please refer to the LCD for reasonable and necessary requirements.

Table of Various AECG Monitors

Type of Monitor Description CPT Codes
External ECG (Holter) Monitors for up to 48 hours by continuous rhythm recording and storage 93224-93227
Extended or long-term external ECG Monitors greater than 48 hours up to 7 days by continuous rhythm recording and storage 93241-93244
Extended or long-term external ECG Monitors greater than 7 days up to 15 days by continuous rhythm recording and storage 93245-93248
External patient-activated/auto-activated ECG rhythm derived event recording (Event monitors) Monitors with symptom-related memory loop with Remote download capability or 24-hour attended monitoring. May be worn for up to 30 days. 93268-93272
External mobile cardiovascular telemetry monitors Concurrent computerized real-time data analysis and greater than 24 hours of accessible ECG data storage with ECG-triggered and patient-selected events transmitted to a remote attended surveillance center. May be worn for up to 30 days 93228- 93229
Subcutaneous Cardiac Rhythm Monitor (SCRM) Implanted, continuous recording that is patient or rhythm activated. The recording is transmitted for delayed interpretation and/or is interpreted by a 24- hour attendant surveillance office in real time. 93298


Refer to the National Coverage Determination NCD 20.15 - Electrocardiographic Services for monitoring after post-infarct guidelines.


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.

Consistent with Current Procedural Terminology (CPT) instruction, report CPT codes 93228 and 93229 only once per 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 medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed. It is not enough to link the procedure code to a correct, payable ICD-10-CM diagnosis code. Consistent with the LCD, the diagnosis or clinical suspicion of a cardiac event, leading to cardiac monitoring, must be present in the medical record.
  4. Medical record documentation should support the medical necessity for greater than 24-hour monitoring and should support the medical necessity for the type of monitoring utilized.
  5. Medical record documentation must support the presence of specific symptoms such as syncope, dizziness, shortness of breath, chest discomfort, palpitations, other abnormal test results which would indicate the need for extended monitoring, or an underlying history of cardiac disease that may correlate with a cardiac diagnosis.
  6. The AECG rhythm strip transmission for 24-hour attended monitoring stations should include the following information:
    • the name of the patient,
    • the presenting diagnosis,
    • the time and date of the transmission,
    • the channel of the AECG transmission,
    • the PR interval (when abnormal),
    • the QRS interval (when abnormal),
    • the rate,
    • the rhythm,
    • cardiovascular symptomatology reported by the patient, or lack of symptoms, at the time of the transmission; and
    • any necessary actions (e.g., notification of physician, emergency instructions given to patient, etc.) taken by the staff should be included in the report.
  7. The medical record should include the interpretation of the monitoring along with the name of the interpreting physician.

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
99999 Not Applicable
N/A

CPT/HCPCS Codes

Group 1

(20 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
93268 Ecg record/review
93270 Remote 30 day ecg rev/report
93271 Ecg/monitoring and analysis
93272 Ecg/review interpret only
93297 Rem interrog dev eval icpms
93298 Rem interrog dev eval scrms
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

(153 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, 93248, 93268, 93270, 93271, 93272, 93297, and 93298.

Group 1 Codes
Code Description
G45.3 Amaurosis fugax
G45.8 Other transient cerebral ischemic attacks and related syndromes
G45.9 Transient cerebral ischemic attack, unspecified
G90.01 Carotid sinus syncope
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.81 Angina pectoris with coronary microvascular dysfunction
I20.89 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
I21.A1 Myocardial infarction type 2
I21.A9 Other myocardial infarction type
I21.B Myocardial infarction with coronary microvascular dysfunction
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
I23.7 Postinfarction angina
I24.81 Acute coronary microvascular dysfunction
I24.89 Other forms of acute ischemic heart disease
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 Atherosclerotic 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
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
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
I25.720 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
I25.730 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
I25.750 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
I25.760 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
I25.790 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
I25.792 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
I25.810 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
I25.82 Chronic total occlusion of coronary artery
I25.83 Coronary atherosclerosis due to lipid rich plaque
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.85 Chronic coronary microvascular dysfunction
I25.89 Other forms of chronic ischemic heart disease
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
I43 Cardiomyopathy in diseases classified elsewhere
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
I45.0 Right fascicular block
I45.19 Other right bundle-branch block
I45.2 Bifascicular block
I45.3 Trifascicular block
I45.5 Other specified heart block
I45.6 Pre-excitation syndrome
I45.81 Long QT 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
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
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
I5A Non-ischemic myocardial injury (non-traumatic)
I63.9* Cerebral infarction, unspecified
I97.120 Postprocedural cardiac arrest following cardiac surgery
I97.121 Postprocedural cardiac arrest following other surgery
I97.190 Other postprocedural cardiac functional disturbances following cardiac surgery
I97.191 Other postprocedural cardiac functional disturbances following other surgery
Q20.3 Discordant ventriculoarterial connection
Q20.5 Discordant atrioventricular connection
Q20.8 Other congenital malformations of cardiac chambers and connections
Q20.9 Congenital malformation of cardiac chambers and connections, unspecified
Q21.11 Secundum atrial septal defect
Q21.12 Patent foramen ovale
Q21.13 Coronary sinus atrial septal defect
Q21.21 Partial atrioventricular septal defect
Q21.22 Transitional atrioventricular septal defect
Q21.23 Complete atrioventricular septal defect
Q21.3 Tetralogy of Fallot
Q24.6 Congenital heart block
R00.0 Tachycardia, unspecified
R00.1 Bradycardia, unspecified
R00.2 Palpitations
R00.8 Other abnormalities of heart beat
R06.00 Dyspnea, unspecified
R06.01 Orthopnea
R06.02 Shortness of breath
R06.09 Other forms of dyspnea
R07.1 Chest pain on breathing
R07.2 Precordial pain
R07.89 Other chest pain
R07.9 Chest pain, unspecified
R10.13 Epigastric pain
R40.4 Transient alteration of awareness
R42 Dizziness and giddiness
R55 Syncope and collapse
Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
Z86.74 Personal history of sudden cardiac arrest
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*ICD-10-CM code I63.9 should be used to report cryptogenic stroke

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
99999 Not Applicable
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
01/01/2024 R3

Article revised and published on 01/25/2024 effective for dates of service on and after 01/01/2024 to reflect the Annual HCPCS/CPT Code Updates. HCPCS code G2066 has been deleted and therefore has been removed from the article. Additionally, CPT code 93297 has been added to the article.

10/01/2023 R2

Article revised and published on 10/26/2023 effective for dates of service on or after 10/01/2023 to reflect the Annual ICD-10-CM Code Updates. The following ICD-10 codes have been added to the article: I20.81, I20.89, I21.B, I24.81, I24.89, I25.85, I47.11, I47.19 in Group 1 Codes. The following ICD-10 codes have been deleted and therefore removed from the article: I20.8, I24.8, I47.1 in Group 1 Codes. For the following ICD-10 code in Group 1 the code descriptor has changed: I25.112.

06/11/2023 R1

Article revised and published on 08/31/2023 effective for dates of service on or after 06/11/2023 in response to an inquiry. A typographical error in the Table of Various AECG Monitors in the CPT codes listed for the second Type of Monitor has been corrected. The following ICD-10-CM codes have been added to Group 1 codes: Q20.3, Q20.5, Q20.8, Q20.9, Q21.11, Q21.12, Q21.13, Q21.21, Q21.22, Q21.23, Q21.3 and Q24.6. 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Public Versions
Updated On Effective Dates Status
01/19/2024 01/01/2024 - N/A Currently in Effect You are here
10/20/2023 10/01/2023 - 12/31/2023 Superseded View
08/25/2023 06/11/2023 - 09/30/2023 Superseded View
04/21/2023 06/11/2023 - N/A Superseded View

Keywords

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