Billing and Coding: Surveillance of Implantable or Wearable Cardioverter
Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based

  
Implanted cardioverter-defibrillators require periodic evaluation of function
and reprogramming based upon the patient's medical condition. Interrogation
may be provided during a face-to-face encounter or remotely. The interrogation
and evaluation may be provided as routine follow-up in an asymptomatic patient
without device discharge, or for symptoms, with device discharge.
Reprogramming should be reflected by a need for change in the patient's
medical condition.  
  
Remote interrogation is a 90-day service, inclusive of all transmissions
during that period which are then billed as a single service. A provider may
not bill a remote service and a face-to-face service on the same day.  
  
Medicare will cover surveillance of ICDs as a face-to-face or remote service
to monitor behavior of the device, to investigate symptoms such as post-event
shock, and syncope, ICD malfunction or device failure. Surveillance of ICDs is
also indicated to program device evaluation and adjustment and for patients
prior to surgery or other procedures to modify or disable the device during
the procedure. Remote interrogation is a single 90-day service, while in-
person interrogation can be reported for each day it is performed.  
  
Peri-procedural device evaluation and programming before and/or after a
procedure or test may be reported separately.  
  
 **Billing Information:**

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 UPIN or
NPI of the referring/ordering physician must be reported on the claim.  
  
The diagnosis code(s) must best describe the patient's condition for which the
service was performed.  
  
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.  
  
 _Advance Beneficiary Notice of Noncoverage (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.

  
Surveillance of an ICD is indicated to monitor the behavior of the device and
to assess the patient with intervening symptoms. The frequency and need for
both face-to-face and remote interrogation should be coordinated so that there
is no unnecessary duplication of the interrogation services.  
  
The symptoms requiring unscheduled investigation by both remote and face-to-
face modalities should be discrete symptoms such as post-shock events,
syncope/near-syncope and palpitations. Remote and face-to-face interrogations
may be performed for suspected malfunction or device failure.  
  
In-person evaluation/interrogation services (93287, 93289, and 93292) may be
reported each time they are provided (reimbursement is dependent upon
documentation of medical necessity).  
  
Remote interrogation services 93295 and 93296 are 90-day services, and may
only be reported once during that period regardless of the number of
interrogations performed. The 90-day period begins with the initiation of
remote monitoring or the 91st day of the implantable defibrillator.  
  
In-person interrogation occurring during the same 90-day period as remote
interrogation is included in the remote interrogation service. If there is no
interrogation service provided within a 90-day period then the service should
not be billed for that period. Programming services may be reported
separately.  
  
In-person interrogation performed on the same day as the programming of the
device is included in the programming service.  
  
Interrogation and reprogramming of defibrillators prior to and after a
surgical procedure or test (93287) is covered as a separate procedure when it
is necessary to modify how the device would function during the procedure/test
(e.g., to avoid interference by an electrical cautery during the procedure, to
disable during cardiac surgery, etc).  
  
When performing program device evaluation with iterative adjustment of the
device to test function and select optimal programmed parameters, the final
parameters may or may not change from previous parameters. Documentation of
each parameter tested and the result should be maintained in the record.  
  
For physician billing, each interrogation, with/without reprogramming must be
provided under  **direct** supervision of the physician in a hospital or other
facility setting and also direct supervision in the office or private clinic
setting. The physician must personally review and analyze the data, generate a
report **and sign it**.  
  
For hospital billing, the technical component of these tests, each
interrogation, with/without reprogramming must be provided under direct
supervision of a qualified physician in the hospital. A qualified physician
must personally review and analyze the data, generate a report **and sign it
if a professional component (-26) is  billed.  If performed in the hospital, a
physician cannot bill for the technical component.**  
  
When the technical portion of interrogation services are provided by a service
center (IDTF, hospital based laboratory, etc), or physician other than the one
analyzing and interpreting the results (93296), the physician performing the
review, analysis and report must generate his/her own interpretation and
report (with signature) and not just countersign the technical review and
distribution of results.  
  
These evaluation/interrogation services should not be billed when implanting
or replacing an ICD.  
  
The service must be prescribed by a physician or a qualified non-physician
practitioner.  
  
An evaluation and management (E&M) service provided on the same day as in-
person interrogation/programming must be a significant and separately
identifiable face-to-face service. No part of the ICD surveillance (face-to-
face or Internet based) may be reported as an E&M service. A brief history to
ascertain whether the device has discharged or patient has had symptoms
relevant to the need for the device (and therefore function) is considered
part of the surveillance service. EKG rhythm strips (93040-93042) are included
in these evaluation/interrogation services and should not be billed
separately.  
  
Coverage is limited to system(s) approved by the FDA for patients with a
specific implanted ICD model.  
  
Only physicians who have expertise and/or training in reprogramming of ICDs
may bill the interrogation with or without reprogramming services.  
  
 **Utilization Guidelines:**  
The frequency and need for both face-to-face and web-based modalities should
be coordinated so that there are no unnecessary duplications of the
interrogation services.  
  
When the in-person service is rendered for monitoring purposes only, in the
absence of symptoms or discharge of the device (ICD-10-CM code Z95.810), it is
expected that the service be performed no more frequently than once every
three months. Remote interrogation services may be billed no more often than
once every 90 calendar days.  
  
When the in-person service is rendered for other indications, it may be
performed as appropriate based on clinical symptomatology.  
  
**Documentation Requirements:**  
The patient's medical record must contain documentation that fully supports
the medical necessity for services included within this article. This
documentation includes, but is not limited to, relevant medical history,
physical examination, and results of pertinent diagnostic tests or procedures.  
  
An Internet based service may require a signed service agreement between the
manufacturer and the physician. This agreement should be kept on file and be
available upon request.  
  
When the technical portion of interrogation services are provided by a service
center (IDTF, hospital based laboratory, etc), or physician other than the one
analyzing and interpreting the results (93296), the physician performing the
review, analysis and report must generate his/her own interpretation and
report (with signature) and not just countersign the technical review and
distribution of results.  
  
All of the following must be maintained in the patient's medical record in the
physician's office: date(s) of device implant and identification of device, a
copy of the physician's order for the service, all transmissions, formal
interpretations, reports, information relating the reason for the service:
routine follow-up versus specific symptoms. If the reason for the service is
that the patient was symptomatic, then the nature of the symptoms must be
documented.  
  

**Evaluation/Interrogation Billing:**  
In-person evaluations/interrogation services (93287, 93289, and 93292) may be
reported each time the services are provided (reimbursement is dependent upon
documentation of medical necessity). These services should not be billed when
implanting or replacing an ICD.  
  
Remote interrogation services 93295 and 93296 are 90-day services, and may
only be reported once during that period regardless of the number of
interrogations performed. The 90-day period begins with the initiation of
remote monitoring or the 91st day of the implantable defibrillator.  
  
In-person interrogation occurring during the same 90-day period as remote
interrogation is included in the remote interrogation service and should not
be separately billed for that period. If there is no interrogation service
provided within a 90-day period then the service should not be billed for that
period. Programming services may be reported separately.  
  
In-person interrogation performed on the same day as the programming of the
device is included in the programming service and should not be separately
billed.  
  
Remote services should be reported with the place of service where the
physician or service center is located, and not the location of the patient.  
  
CPT code 93287 should be billed for interrogation and reprogramming of
defibrillators prior to and after a surgical procedure or test if it is
necessary to modify how the device would function during the procedure/test
(e.g., to avoid interference by an electrical cautery during the procedure, to
disable during cardiac surgery, etc). Therefore, this service may be reported
once before a surgery or other procedure and once after surgery or other
procedure if performed at both times.  
  
The technical portion of interrogation services, when provided by a service
center (IDTF, hospital based laboratory, etc), or physician other than the one
analyzing and interpreting the results should be billed with CPT code 93296.  
  
Providers should only report an evaluation and management (E&M) service on the
same day as in-person interrogation/programming, if it is a significant and
separately identifiable face to face service. In these cases, modifier 25
should be billed with the E&M service.  
A brief history to ascertain whether the device has discharged or patient has
had symptoms relevant to the need for the device (and therefore function) is
considered part of the surveillance service.  
  
EKG rhythm strips (93040-93042) are included in these evaluation/interrogation
services and should not be billed separately.  
  
**ICD-10-CM Coding:**  
Report ICD-10-CM code Z45.02 for interrogation and reprogramming of
defibrillator prior to undergoing a surgical procedure unrelated to
defibrillator.  
  
Report ICD-10-CM code Z48.89 for interrogation and/or reprogramming of
defibrillator following a surgical procedure unrelated to defibrillator.  
  
 **For claims submitted to the Part B MAC:**  
All services/procedures performed on the same day for the same beneficiary by
the physician/provider should be billed on the same claim.  
  
 **Sources of Information:**  
This bibliography presents those sources that were obtained during the
development of this article. National Government Services is not responsible
for the continuing viability of Web site addresses listed below.  
  
American Medical Association, _CPT 2009 Professional Edition,_ pages 408-411.  
  
Medtronic CareLink Network, Fact Sheet, Press Release, Backgrounder by
Medtronic, Inc.  
  
Medtronic completes Phase One of its Medtronic CareLink Patient Management
Network Rollout, Company Press Release, Atlanta-March 18, 2002 @
http://www.cathlab.com.ar/revista/industrial/industria.htm FDA approves Web-
based heart monitoring system by Alicia Ault, New York, Jan 03 (2002), Reuters
Health Information
@http://www.reutershealth.com/archive/2002/01/03/e.../20020103elin021.htm.  
  
New "Smart" Pacemakers, ICDs Will Even Contact Your Doctor For You, News and
Press Releases, San Diego Tuesday, May 07, 2002, North American Society of
Pacing and Electrophysiology (NASPE) @http://www.naspe.org/.  
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