Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring

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.