Procedure code and description

93224 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional – Average fee payment – $93

93225 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection) – Average fee payment – $27

93226  – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report  Average fee payment – $38



93227 – External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional – $27


Holter

The following is a summary of Current Procedural Terminology (procedure ) codes commonly used for various Holter monitoring procedures performed with a Midmark Holter device. This information is provided only as a guide and is not intended to replace any official recommendations or guidelines, and does not constitute a promise or guarantee by Midmark regarding coverage or payment. Always check with the specific payer for the appropriate use of any procedure  or ICD-10 codes. Physician fee schedule values listed are based on a national average and are rounded for brevity.

Specific payments vary geographically. Codes and rates are subject to change. It is the responsibility of the provider to determine the correct coding for services provided.


procedure  Manual Instructions for Cardiovascular Monitoring Services

• Cardiovascular monitoring services are diagnostic medical procedures using in-person  and remote technology to assess cardiovascular rhythm (ECG) data.

• Holter monitors (93224-93227) include up to 48 hours of continuous recording.

Report proper ICD-10-CM diagnosis codes to support the medical necessity for the use a Holter monitor. ICD-10-CM codes and/or ranges are provided below to help with your decision process.



ICD-10-CM Description             ICD-10-CM  Code/ Range

Abnormalities of breathing R06.00-R06.9

Abnormalities of heart beat R00.0-R00.9

Aneurysm of heart I25.3

Angina pectoris 120.0-120.9

Atrial fibrillation and flutter I48.0-I48.92

Bradycardia, unspecified R00.1

Cardiac arrest I46.2-I46.9

Cardiac murmurs and other cardiac sounds R01.0-R01.2

Chronic ischemic heart disease I25.10-I25.9

Dizziness and giddiness R42

Gangrene, not elsewhere classified I96

Old myocardial infarction I25.2

Other cardiac arrhythmias I49.0-I49.9

Pain in chest R07.1-R07.9

Paroxysmal tachycardia I47.0-I47.9

ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction I21.0-I21.4

Subsequent ST elevation (STEMI) and  non-ST elevation (NSTEMI) myocardial

infarction I22.0-I22.9

Syncope and collapse R55



External Electrocardiographic Recording Services – CPT codes 93224, 93225, 93226, and 93227 Reported with Modifier 52

CPT codes 93224 – 93227 are reported for external electrocardiographic recording services up to 48 hours by continuous rhythm recording and storage. CPT coding guidelines for codes 93224 – 93227 specify that when there are less than 12 hours of continuous recording modifier 52 (Reduced Services) should be used.

When modifier 52 is appended to CPT code 93224, 93225, 93226, or 93227, Oxford does not apply the Time Span Codes Policy for reimbursement of these codes. Instead, Oxford applies the “Reduced Services Policy” which addresses reimbursement for codes appended with modifier 52.

Coding Guidelines

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This information does not take precedence over CCI edits. Please refer to CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare

1. *CPT codes for holter monitoring services (CPT codes 93224-93227) are intended for up to 48 hours of continuous recording. For 48 hour monitoring codes (CPT 93224-93227):

a. The documentation in the progress notes must reflect medical necessity for the service.

b. These services may be reported globally with CPT codes 93224. Use the date of physician review as the date of service (DOS).

c. When submitting claims for the recording only (CPT code 93225) or for the analysis with report only (CPT code 93226) use the date the service was performed as the DOS.

d. When submitting claims for physician review and interpretation (CPT code 93227) use the date the service was performed as the DOS.

e. For less than 12 hours continuous recording, modifier -52 (reduced services) should be appended. (2011 Insider’s View p. 181)

2. List the ICD-9 code(s) indicating the reason for the test.

3. The name and NPI number of the referring/ordering physician or qualified non-physician practitioner must be reported in boxes 17 and 17a of CMS-1500 form or in the EAO record fields 20.0 (for NPI number) and 22.0 (name) when submitting electronically.

4. The physician interpreting the test must be identified on the claim form with his/her sequence number in Box 24K. For EMC, use NSF format field FA0 – 23, or ANSI – 837 or NM1 – 09 (loop 2310).

5. The codes describing technical work may be billed by an independent diagnostic testing facility (IDTF) if they meet all requirements listed in the code descriptions and coverage requirements. They may bill the total component only if the physician interpreting the test is employed or contracted by the IDTF and is not billing for the interpretation separately. The physician’s name and address must be on record with our WPS Provider Enrollment Department. A letter should be sent by the physician assigning all monies collected by the IDTF for the professional codes to the billing IDTF. If a letter is not on file, professional services billed by the IDTF will be denied.
6. Do not use the “TC” or “26” modifier with the codes 93224-93229, 93268, 93270, 93271, or 93272, listed in the CPT/HCPCS section of the LCD.
7. For the same dates of service, either the wearable patient monitor or the up to 48-hour monitor will be covered (not both).
8. External Mobile Cardiac Telemetry Monitors

As of 01/01/2009, CPT codes 93228 and 93229 describe wearable mobile cardiovascular telemetry services. Because of this, wearable mobile cardiovascular telemetry services should no longer be reported using 93799 Providers are instructed to bill one (1) unit of procedure code 93228 and/or 93229 per a course of treatment that includes up to 30 consecutive days of cardiac monitoring

Holter monitoring is a form of long-term ECG recording. It is a diagnostic procedure that provides a continuous record of electrical activity of a patient’s heart while the individual is engaged in ordinary activities, including sleep. Holter monitoring is used to detect abnormalities related to rhythm, rate, conduction and ischemia, which are not observed using a standard ECG.
Basic components of Holter monitoring systems are a sensing element, an appropriate recording of ECG information or significant variations in rate or arrhythmia, and a component for graphically recording ECG data or for visual or computer assisted analyses of recorded taped information.

Indications
  • Detecting transient episodes of cardiac dysrhythmia, permitting correlation of these episodes with cardiovascular symptoms.
  • Evaluation of the patient with symptoms suggestive of a cardiac dysrhythmia when another cause cannot be established.
  • Evaluation of arrhythmias in patients with documented coronary artery disease, including the assessment of the immediate postmyocardial infarction patient.
  • Monitoring the effectiveness of antiarrhythmic therapy.
  • Syncope and presyncope are covered indications for Holter monitoring and real-time monitoring.


Limitations
  • Holter monitoring and real-time monitoring are not covered for the detection of silent ischemia in patients without symptoms suggestive of ischemia. Routine screening in the absence of signs, symptoms, and complaints is not covered under Title XVIII of the Social Security Act, Section 1862(a)(7).
  • Holter monitoring and real-time monitoring are not covered for patients with incidental findings of conduction system defects absent a qualifying indication listed above.
  • Holter monitoring and real-time monitoring for vague symptoms such as dizziness are not covered in the absence of symptoms or signs that would suggest cardiac origin of the symptoms.
Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

  • 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.

CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of shortCPT descriptors in policies published on the Web.
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



Medicare Billing Guidelines

CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:

a. Patient hook-up and patient-specific instruction and education
b. Transmission and receipt of ECG
c. Analysis of ECG by nonphysician personnel
d. Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
e. Equipment maintenance.
f. All supplies necessary for completion of the monitoring

CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.

The following documentation requirements apply to all claims reporting CPT code 93228 and/or 93229:

a. The date of service must be reported as the date the patient was initially placed on the monitor.

b. A monitoring episode (one to 30 consecutive days) is reported as a unit of one.

c. Any additional claims reporting procedure code 93228 or 93229 for ECG arrhythmia detection and alarm system within an episode of care (one to 30 days after an initial service) will be denied.

GY and GZ Modifiers

When billing for services, requested by the beneficiary for denial, that are statutorily excluded by Medicare (i.e. screening), report a screening ICD-9 code and the GY modifier (items or services statutorily excluded or does not meet the definition of any Medicare benefit) When billing for services, requested by the beneficiary for denial, that would be considered not reasonable and necessary, report an ICD-9 code that best describes the patients condition and the GA modifier if an ABN signed by the beneficiary is on file or the GZ modifier (items or services expected to be denied as not reasonable) when there is no ABN for the service on file.

B. Types of monitoring and coverage:

1. Continuous up to 48-hour Monitoring (CPT codes 93224-93227), includes a coverage period of up to 48-hours for one unit of service. No other EKG monitoring codes can be billed simultaneously with these codes.

2. CPT codes 93268-93272

Cardiac event monitor technology varies among different devices. For patient-activated event monitors, the patient initiates recording when symptoms appear or when instructed to do so by a physician (e.g., following exercise). For self-sensing automatically triggered monitors, an EKG is automatically recorded when the device detects an arrhythmia, without patient intervention. Some devices permit a patient to transmit EKG data trans-telephonically (i.e., via telephone) to a receiving center where the data is reviewed. A technician may be available at these centers to review transmitted data 24- hours per day. In some instances, when the EKG is determined to be outside certain preset criteria by a technician or other non-physician, a physician is available 24 hours per  day to review the transmitted data and make clinical decisions regarding the patient. These services are known as 24 hour “attended monitoring”. In other instances, transmitted EKG data is reviewed at a later time and are, therefore, considered “nonattended.”
.
a. The person receiving the transmission must be a technician, nurse, or a physician trained in interpreting ECG’s and abnormal rhythms.

b. A physician must be available 24 hours a day for immediate consultation to review the transmission in case of significant symptoms or ECG abnormalities

3. Additionally, the transmitting devices must meet at least the following criteria;

a. They must be capable transmitting EKG Leads I, II or III; and

b. The tracing must be sufficiently comparable to a conventional EKG. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI is only covered if provision is made for such 24-hour attended coverage in the manner described below.

4. 24-hour attended coverage means there must be, at a monitoring site or central data center, an EKG technician or other non-physician, receiving calls and/or EKG data. Tape recording devices do not meet this requirement. Further, such technicians should have immediate 24-hour access to a physician to review transmitted data and make clinical decisions regarding the patient.

5.The technician should also be instructed as to when how to contact available facilities to assist the patient in case of emergencies.

6. Nationally Non-covered Indications

The following indications are non-covered nationally unless otherwise specified below:

a. The time-sampling mode of operation of ambulatory EKG cardiac event monitoring recording.

b. Separate physician services other than those rendered by an IDTF unless rendered by the patient’s attending or consulting physician.

c. Home EKG services without documentation of medical necessity.

d. Emergency EKG services by a portable x-ray supplier without a physician in attendance at the time of the service or immediately thereafter.

e. 24-hour attended coverage used as early post-hospital monitoring of patients discharged after MI unless provision is made for such 24-hour attended coverage in the manner described in section 4 above.
 

Coverage Indications, Limitations, and/or Medical Necessity


Long-Term ECG Monitoring is defined as a diagnostic procedure, which can provide continuous recording capabilities of ECG activities of the patient’s heart while the patient is engaged in daily activities. These can include continuous, patient-demand or auto-detection devices. The purpose of these tests is to provide information about rhythm disturbances and waveform abnormalities and to note the frequency of their occurrence.


Cardiac Event Detection (CED) is a 30-day service for the purpose of documentation and diagnosis of paroxysmal or suspected arrhythmias. 


Holter Monitoring (24-hour ECG monitoring) is a study used to evaluate the patient’s ambient heart rhythm during a full day’s (24 Hours) cycle. It is a wearable EKG monitor that records the overall rhythm and significant arrhythmias. 


Medical Necessity:


The medical necessity indications listed in this policy must be present in order for these tests to be covered.


Indications for external 48-hour ECG recording include one or more of the following:


Symptoms:


Arrhythmias


Chest pain


Syncope (lightheadedness) or near syncope


Vertigo (dizziness)


Palpitations


Transient ischemic episodes


Dyspnea (shortness of breath)


Evaluation of the response to antiarrhythmic drug therapy.


Evaluation of myocardial infarction (MI) survivors with an ejection fraction of 40% or less.


Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.


Other acute and subacute forms of ischemic heart disease.


To detect arrhythmias post ablation procedures.


The use of 0295T, 0296T, 0297T and 0298T, external electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage, may be considered medically necessary in patients treated for reasons listed in the diagnosis list to monitor for asymptomatic episodes in order to evaluate treatment response. The use of external electrocardiographic event monitors for more than 48 hours up to 21 days that are either patient-activated or auto-activated may be considered medically necessary as a diagnostic alternative to Holter monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope, or syncope).


Long term 30-day monitoring: Telephonic Transmission of ECG involves 24 hour attended monitoring per 30 day period of time; no other EKG monitoring codes can be billed simultaneously with these codes.
Indications for performing a Telephonic Transmission:
Arrhythmias


Chest pain


Syncope (lightheadedness) or near syncope


Vertigo (dizziness)


Palpitations


Transient ischemic episodes


Dyspnea (shortness of breath)


To initiate, revise or discontinue arrhythmia drug therapy.


Evaluation of myocardial infarction (MI) survivors.


Evaluation of acute and subacute forms of ischemic heart disease.


Assessment of patients with coronary artery disease with active symptoms, to correlate chest pain with ST-segment changes.

Home Telemetry – Medicaid Authorization requirements

Outpatient long-term cardiac (Holter) monitoring codes 93224, 93225, 93226, and 93227 will require prior authorization if more than 3 units of any code are reported in one year. Prior authorization will use the following criteria:

**   Outpatient long-term cardiac (Holter) monitoring must be ordered by a neurologist
**   Member must have had a stroke or TIA with no identifiable cause
**   Member should have already had 24 hour monitoring done previously (either with outpatient long-term cardiac monitoring or as inpatient with telemetry)
**   Member should not be currently anti-coagulated on Warfarin for any other reason
**   Member should not have a known contraindication for Warfarin
**   Outpatient long-term cardiac monitoring may only be authorized for the 30-day test
**   Data from the test must be reviewed and interpreted by a cardiologis


Electrocardiograph Holter Monitoring Policy Status: Active  Effective: 12/01/2012


Please note: All policies are subject to the terms, conditions and limitations of the member’s plan or program


Description


Holter monitors are portable devices that capture 48 hours or more of continuous external electrocardiographic (ECG) recording and storage, and are used to detect atypical heart rhythms.


The services comprising Holter monitoring can be reported by using one Current Procedural Terminology (procedure ®) code for the global service, or they can be reported by using a combination of the professional and technical component codes for:


• recording of the ECG (which includes the hook-up and disconnection)


• scanning analysis with report


• physician review and interpretation


Policy


1. Non-hospital setting:


ECG Holter Monitoring is eligible for reimbursement when billed as a global service which encompasses both the technical and the professional components, or when a combination of the technical and the professional component services are reported. When a participating provider utilizes an outside non-par vendor for some or all of the technical components of this service, the participating provider is responsible for billing the global service (technical and professional components) and reimbursing the subcontracted vendor.


This will avoid increased member financial liability due to your use of an out-of-network provider as well as member abrasion.


 2. Hospital Setting:


Hospital-Based Physicians and private physicians are only eligible to be reimbursed for the professional component. The hospital may bill for the technical components.


Coding Holter Monitoring


93224—-external electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation


93225—-recording (includes connection, recording, and disconnection)


93226—-scanning analysis with report


93227—-physician review and interpretation

ICD-10 CODE DESCRIPTION


I20.0 Unstable angina


I20.1 Angina pectoris with documented spasm


I20.8 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


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


I24.0 Acute coronary thrombosis not resulting in myocardial infarction


I24.1 Dressler’s syndrome


I24.8 Other forms of acute ischemic heart disease


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


I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris


I25.2 Old myocardial infarction


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


I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of 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


I25.718 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


I25.728 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


I25.738 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


I25.758 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


I25.768 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


I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris


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


I44.7 Left bundle-branch block, unspecified


I45.0 Right fascicular block


I45.19 Other right bundle-branch block


I45.2 Bifascicular block


I45.3 Trifascicular block


I45.4 Nonspecific intraventricular block


I45.5 Other specified heart block


I45.6 Pre-excitation syndrome


I45.81 Long QT syndrome


I45.89 Other specified conduction disorders


I47.0 Re-entry ventricular arrhythmia


I47.1 Supraventricular tachycardia


I47.2 Ventricular tachycardia


I47.9 Paroxysmal tachycardia, unspecified


I48.0 Paroxysmal atrial fibrillation


I48.1 Persistent atrial fibrillation


I48.2 Chronic 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


I49.5 Sick sinus syndrome




I49.8 Other specified cardiac arrhythmias


R00.1 Bradycardia, unspecified


R00.2 Palpitations


R06.01 Orthopnea


R06.02 Shortness of breath


R06.09 Other forms of dyspnea


R06.2 Wheezing


R06.3 Periodic breathing


R06.4 Hyperventilation


R06.81 Apnea, not elsewhere classified


R06.82 Tachypnea, not elsewhere classified


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


R29.5 Transient paralysis


R40.4 Transient alteration of awareness


R42 Dizziness and giddiness


R55 Syncope and collapse


Z79.891 Long term (current) use of opiate analgesic


Z79.899 Other long term (current) drug therapy



ICD-9-CM Codes That Support Medical Necessity

The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes 93224, 93225, 93226 and 93227:
Covered for:
345.00–345.01
Epilepsy and recurrent seizures
345.10–345.11
Epilepsy and recurrent seizures (generalized)
345.2–345.3
Epilepsy and recurrent seizures (mal status)
345.40–345.41
Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures
345.50–345.51
Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures
345.60–345.61
Infantile spasms
345.70–345.71
Epilepsia partialis continua
345.80–345.81
Other forms of epilepsy and recurrent seizures
345.90–345.91
Epilepsy unspecified
410.00–410.02
Acute myocardial infarction
410.10–410.12
Acute myocardial infarction of other anterior wall
410.20–410.22
Acute myocardial infarction of inferolateral wall
410.30–410.32
Acute myocardial infarction of inferoposterior wall
410.40–410.42
Acute myocardial infarction of other inferior wall
410.50–410.52
Acute myocardial infarction of other lateral wall
410.60–410.62
True posterior wall infarction
410.70–410.72
Subendocardial infarction
410.80–410.82
Acute myocardial infarction of other specified sites
410.90–410.92
Acute myocardial infarction of unspecified site
411.0–411.1
Other acute and subacute forms of ischemic heart disease
411.81–411.89
Acute coronary occlusion without myocardial infarction
412
Old myocardial infarction
413.0–413.1
Angina pectoris
413.9
Other and unspecified angina pectoris
414.00–414.07
Other forms of chronic ischemic heart disease
414.10–414.12
Aneurysm and dissection of heart
414.19
Other aneurysm of heart
414.8–414.9
Other forms of chronic ischemic heart disease
422.0
Acute myocarditis in diseases classified elsewhere (Note: code underlying disease first.)
422.90–422.93
Other and unspecified acute myocarditis
422.99
Other myocarditis
424.0
Mitral valve disorders
425.0–425.5
Cardiomyopathy
426.0
Atrioventricular block complete
426.10–426.13
Atrioventricular block, other and unspecified
426.2–426.4
Conduction disorders
426.51–426.54
Bundle branch block, other and unspecified
426.7
Anomalous atrioventricular excitation
426.9
Conduction disorder, unspecified
427.0–427.2
Cardiac dysrhythmias
427.31–427.32
Atrial fibrillation and flutter
427.41–427.42
Ventricular fibrillation and flutter
427.5
Cardiac arrest
427.60–427.61
Premature beats
427.69
Other premature beats
427.81
Sinoatrial node dysfunction
427.89
Other specified cardiac dysrhythmias
427.9
Cardiac dysrhythmia unspecified
428.0–428.1
Heart failure
428.20–428.23
Systolic heart failure
428.30–428.33
Diastolic heart failure
428.40–428.43
Combined systolic and diastolic heart failure
428.9
Heart failure unspecified
429.0
Myocarditis, unspecified
429.4
Functional disturbances following cardiac surgery
429.83
Takotsubo syndrome
434.10–434.11
Cerebral embolism
435.8–435.9
Transient cerebral ischemia
674.50–674.54
Peripartum cardiomyopathy
780.2
Syncope and collapse
780.31–780.32
Convulsions
780.39
Other convulsions
780.4
Dizziness and giddiness
785.0–785.1
Symptoms involving cardiovascular system
786.00–786.09
Symptoms involving respiratory system and other chest symptoms
786.50–786.52
Chest pain
786.59
Other chest pain
794.30–794.31
Cardiovascular (abnormal)
794.39
Other nonspecific abnormal function study of cardiovascular system
996.01–996.04
Mechanical complication of cardiac device, implant and graft
996.09
Other mechanical complication of cardiac device implant and graft
996.72
Other complications due to other cardiac device implant and graft
V12.53
Personal history of sudden cardiac arrest
V45.01
Cardiac pacemaker in situ
V45.02
Automatic implantable cardiac defibrillator in situ
V45.09
Other specified cardiac device in situ
V58.69
Long-term (current) use of other medications
V67.51
Follow-up examination following completed treatment with high-risk medication not elsewhere classified
Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims.
DESCRIPTION OF SERVICES

Cardiac arrhythmias are abnormal heart rhythms. Although some patients with arrhythmias may experience palpitations, weakness, dizziness or fainting, other patients may have no symptoms at all. Effective treatment requires an accurate diagnosis. This can be difficult since arrhythmias can occur infrequently and unpredictably and may be asymptomatic (ECRI, 2014). The type and duration of ambulatory electrocardiography (ECG) monitoring is dictated by the frequency of symptoms.

• Holter monitors are portable devices that record heart rhythms continuously for up to 48 hours. These devices are used to record events that occur at least once a day.

• Non-implantable cardiac event monitors are portable devices that record heart rhythms intermittently for up to 30 days.

These devices capture ECG data before, during and after the time of activation.

• Standard loop recorders have just a few minutes of memory. Newer, more sophisticated devices have extended memory features that can store up to several hours of ECG data.

Recording can be patient-activated when symptoms occur or automatically triggered based on a computer algorithm designed to detect arrhythmias. These devices are used to record infrequent or irregular events.

Documentation Requirements
  • Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
  • A formal report for every study must be generated that indicates the reason(s) for the test and includes the electrocardiographic interpretation.
  • An appropriate medical evaluation of the patient prior to the test must be documented in the patient’s record by the referring physician. This should include a history and physical examination that is of sufficient scope and detail to support medical necessity for the test.
  • To verify the necessity and reasonableness of the test, the performing physician should, at minimum, document the diagnostic impression of the referring physician and indicate the patient’s relevant signs, symptoms or pertinent history in his records. The simple statement of certain non-specific test indications (such as chest pain or palpitations, etc.) is unacceptable medical necessity documentation.