Article - Billing and Coding: Ambulatory Electrocardiograph (AECG) Monitoring (A59268)

CMS National Coverage PolicySocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Medicare National Correct Coding Initiative (NCCI) Policy Manual:Chapter 1, Section E Modifiers and Modifier Indicators and Section V Medically Unlikely Edits (MUEs).Article TextThis 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 MonitorsType of MonitorDescriptionCPT CodesExternal ECG (Holter)Monitors for up to 48 hours by continuous rhythm recording and storage93224-93227Extended or long-term external ECGMonitors greater than 48 hours up to 7 days by continuous rhythm recording and storage93241-93244Extended or long-term external ECGMonitors greater than 7 days up to 15 days by continuous rhythm recording and storage93245-93248External 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.93268-93272External mobile cardiovascular telemetry monitorsConcurrent 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 days93228- 93229Subcutaneous 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.93298Refer to the National Coverage Determination NCD 20.15 - Electrocardiographic Services for monitoring after post-infarct guidelines.Coding GuidanceNotice: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 RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.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.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.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.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.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; andany necessary actions (e.g., notification of physician, emergency instructions given to patient, etc.) taken by the staff should be included in the report.The medical record should include the interpretation of the monitoring along with the name of the interpreting physician.