Appeal type: Testing
Decision: Unfavorable

 
We decided that the Plan does not have to pay for procedure codes 93228, 93229, and 93241 rendered from 
February 13, 2023, to February 17, 2023. 
 
You asked the Plan to pay for the services. You say that this should be paid for. The Plan denied your request. 
The Plan says the records do not support the services billed. 
 
The Plan must follow Medicare rules. Medicare rules say that providers must report services correctly. 
Providers must report services with the appropriate CPT code. 
 
In this case, the CPT Code Manual definition of the denied codes is: 
 
CPT 93228: 
 
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG 
triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; 
review and interpretation with report by a physician or other qualified health care professional 
 
CPT 93229: 
 
External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real 
time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG 
triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; 
technical support for connection and patient instructions for use, attended surveillance, analysis and 
transmission of daily and emergent data reports as prescribed by a physician or other qualified health care 
professional 
 
CPT 93241: 
 
External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording 
and storage; includes recording, scanning analysis with report, review and interpretation 
 
We asked our coder to carefully review the case file and apply the relevant Medicare rules to determine if the 
Plan was correct in denying the request to pay for the services. Our reviewer says that the services at issue in 
this case were not supported by the medical records. Our reviewer found that in terms of CPT 93228, the 
medical records do not include sufficient documentation to verify this code. An interpretation with a report was 
not found in the medical record. In terms of CPT 9322, the medical records do not include documentation of 
technical support for connection and patient instructions for use, attended surveillance, analysis and 
transmission of daily and emergent data reports as prescribed by a physician or other qualified health care 
professional.  Therefore, this procedure cannot be verified. Finally, in terms of CPT 93241, the records do not 
include sufficient documentation to verify the procedure billed. For CPT 93241 "the provider applies an 
electrocardiographic, or ECG recorder, to a patient who wears it for more than 48 hours, up to seven days, to 
help detect abnormal heart rates and rhythms. This service includes recording, analyzing, compiling, and 
interpreting the electrocardiographic findings." This procedure was not included in the medical record 
submitted. 
 
We looked at this coder's review, the file, and Medicare rules. Based on this information, we decided that 
Medicare rules for coverage of the services have not been met. Therefore, we decided that the Plan does not 
have to pay for procedure codes 93228, 93229, and 93241 rendered from February 13, 2023, to February 17, 
2023.