The CPT/HCPCS codes that follow have two key distinguishing features:
- The distinction between a monitor with and without presymptom loop.
- The availability of full 24-hour attended coverage for certain specified services.
- To detect, characterize and document symptomatic transient arrhythmias.
- To aid in regulating anti-arrhythmic drug dosage.
- To aid in the search for the cause of unexplained syncope, dizziness or giddiness.
- To detect the presence of symptomatic transient arrhythmias (the frequency of the symptom would make a 24-hour ambulatory electrocardiogram (Holter) not useful in documenting the rhythm).
- To monitor for the purpose of regulating anti-arrhythmic drug dosages.
- To monitor patients who have had surgical or ablative procedures for arrhythmias.
For 24-hour attended monitoring services, the receiving station must be staffed on a 24-hour basis and should be able to direct the patient for the management of all emergencies. An answering service/answering machine would not fulfill this requirement.
In addition, systems utilizing computers to dial the physician’s office so the physician receives transmission by way of a relay is not a covered service since there is no attendance.
A test may be ordered only by a physician or qualified non-physician practitioner treating the beneficiary.
Although the service is a 30-day service, it is recognized that the event recorder may be discontinued once the symptom-producing arrhythmia has been documented and diagnosed or following multiple transmissions during symptoms, without arrhythmia. It is unlikely that the arrhythmias would always be diagnosed on the first day of recording or that the service would always last only one day. The average duration of monitoring is anticipated to last 10–14 days or more.
The Cardiac Event Detection service is justified by the pre-test incidence of symptoms related to arrhythmias and is considered not medically necessary for those patients who are not having significant recurrent arrhythmias that are anticipated to require treatment.
Testing for more than 30 consecutive days is rarely medically necessary and the need for the continued monitoring must be justified by the treating physician. Failure to document an arrhythmia during a 30-day test period is not sufficient justification to reimburse a second or subsequent test. It is unlikely to be medically necessary to repeat a second test within a year in the absence of new or recurrent undiagnosed symptoms.
Event recorders must be patient-activated and may not use time-sampling technology. Accordingly, this test will be considered medically unnecessary for any patient who is unresponsive, comatose, severely confused or otherwise unable to recognize symptoms or activate the recorder.
Event recorders are not covered for outpatient monitoring of recently discharged postinfarct patients.
Because the Cardiac Event Detection service requires the diagnosis and evaluation of intermittent arrhythmias and patients must be continuously attached to presymptom loop recorders or be able to be attached at the start of symptoms to postsymptom loop recorders, each patient is required to have a recorder for his/her own exclusive use throughout the duration of the monitoring period. Recorders may not be “shared” amongst two or more patients, regardless of the environment or site of the service. It will be deemed medically unnecessary to perform cardiac event recording services when patients do not have exclusive use of a recorder for the entire service period (30 days).
Cardiac Event Detection is a 30-day packaged service. Tests may not be billed within 30 days of each other, even if the earlier of the tests was discontinued when arrhythmias were documented and the patient is now reconnected for follow-up of therapy or intervention.
Compliance with the provisions in this policy is subject to monitoring by postpayment data analysis and subsequent medical review.
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Providers are reminded to refer to the long descriptors of the
Ecg record/review (Non-OPPS only)
Ecg recording (Non-OPPS only)
Ecg/monitoring and analysis
Ecg/review, interpret only
Chronic total occlusion of coronary artery
Atrioventricular block complete
Atrioventricular block, other and unspecified
Other specified conduction disorders
Other specified conduction disorders
Conduction disorder unspecified
Atrial fibrillation and flutter
Ventricular fibrillation and flutter
Other premature beats
Sinoatrial node dysfunction
Other specified cardiac dysrhythmias
Unspecified transient cerebral ischemia
Syncope and collapse
Dizziness and giddiness
Symptoms involving cardiovascular system
Respiratory abnormality other
Personal history of sudden cardiac arrest
Follow-up examination following completed treatment with high-risk medication not elsewhere classified
Cardiac rhythm regulators causing adverse effects in therapeutic use
Cardiotonic glycosides and drugs of similar action causing adverse effects in therapeutic use
Other and unspecified agents primarily affecting the cardiovascular system causing adverse effects in therapeutic use
Records must include ECG rhythm strips with interpretation for each transmission, the date and time of each transmission, when the symptoms occurred and what the symptoms were must be documented for each transmission. The medical record should also include when the reviewing physician and the ordering physician were notified of the transmission and its results.
The Cardiac Event Detection provider’s records must include the referring physician’s request for the test and the indications for the test. This information should be incorporated into a formal report (interpretation) of the test.
Documentation of the necessity should include the referring physician’s diagnostic impression and an indication of relevant signs and symptoms.
It is not enough to link the procedure code to a correct, payable ICD-9-CM diagnosis code. The diagnosis or clinical suspicion must be present and documented in the clinical record for the procedure to be paid.