L29162 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING

 

 

10/08/2012

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

This coverage policy is being developed to clearly define the circumstances for which twenty-four hour continuous electrocardiographic monitoring is considered to be medically reasonable and necessary, and therefore covered, by Medicare.

Medicare will consider twenty-four hour electrocardiographic monitoring to be medically necessary in any of the following circumstances (see Covered ICD-9 Codes):

• The patient complains of palpitations, and physical examination and standard EKG have not satisfactorily explained the patient's complaints.

• The patient has experienced an unexplained syncopal episode or the patient has experienced a transient episode of cerebral ischemia which is felt to possibly be secondary to a cardiac rhythm disturbance.

• The patient has been found to have a significant cardiac arrhythmia or conduction disorder (see list below) and holter monitoring is necessary as part of the evaluation and management of the patient:

o Complete Heart Block

o Second Degree AV Block

o New Left Bundle Branch Block

o New Right Bundle Branch Block

o Bifasicular Block

o Paroxysmal SVT

o Paroxysmal VT

o Atrial Fib/Flutter

o Ventricular Fib/Flutter

o Cardiac Arrest

o SA Node Dysfunction

o Frequent PAC's

o Frequent PVC's

o Wandering Atrial Pacemaker

o Unspecified Cardiac Arrhythmia

• The patient has a heart condition (see list below) associated with a high incidence of serious cardiac arrhythmia and/or myocardial ischemia, and holter monitoring is being done as part of the evaluation and management of the patient:

o Dressler's Syndrome

o History of Myocardial Infarction

o Angina Pectoris

o Prinzmetals's Angina

o Aneurysm of Heart Wall

o Chronic Ischemic Heart Disease

o Pericarditis

o Mitral Valve Disease

o Cardiomyopathy

o Anomalous AV Excitation

o Cardiomegaly

o Post Heart Surgery

o Prolonged QT Interval

• The patient has a cardiac arrhythmia or other cardiac condition and a cardiac medication which affects the electrical conduction system of the heart has been prescribed, and holter monitoring is necessary to evaluate the effect of the cardiac medication on the patient's cardiac rhythm and/or conduction system.

• The patient has a pacemaker and clinical findings (history or physical examination) suggest possible pacemaker malfunction.

• Claims submitted for holter studies performed at unusually frequent intervals will be reviewed by Medicare to make certain that the services were medically reasonable and necessary.

 

 

CPT/HCPCS Codes

 

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 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; RECORDING (INCLUDES CONNECTION, RECORDING, AND DISCONNECTION)

 

93226 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; SCANNING ANALYSIS WITH REPORT

 

93227 EXTERNAL ELECTROCARDIOGRAPHIC RECORDING UP TO 48 HOURS BY CONTINUOUS RHYTHM RECORDING AND STORAGE; PHYSICIAN REVIEW AND INTERPRETATION

 

 

ICD-9 Codes that Support Medical Necessity

 

410.00 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.01 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL INITIAL EPISODE OF CARE

410.02 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.10 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.11 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL INITIAL EPISODE OF CARE

410.12 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.20 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.21 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL INITIAL EPISODE OF CARE

410.22 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.30 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.31 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL INITIAL EPISODE OF CARE

410.32 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.40 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED

410.41 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL INITIAL EPISODE OF CARE

410.42 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE

410.50 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED

410.51 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL INITIAL EPISODE OF CARE

410.52 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE

410.60 TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED

410.61 TRUE POSTERIOR WALL INFARCTION INITIAL EPISODE OF CARE

410.62 TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE

410.70 SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED

410.71 SUBENDOCARDIAL INFARCTION INITIAL EPISODE OF CARE

410.72 SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE

410.80 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED

410.81 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES INITIAL EPISODE OF CARE

410.82 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE

410.90 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED

410.91 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE INITIAL EPISODE OF CARE

410.92 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE

411.0 POSTMYOCARDIAL INFARCTION SYNDROME

411.1 INTERMEDIATE CORONARY SYNDROME

411.81 ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION

411.89 OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER

412 OLD MYOCARDIAL INFARCTION

413.0 ANGINA DECUBITUS

413.1 PRINZMETAL ANGINA

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS

414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT

414.01 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY

414.02 CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT

414.03 CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT

414.06 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY OF TRANSPLANTED HEART

414.07 CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART

414.10 ANEURYSM OF HEART (WALL)

414.11 ANEURYSM OF CORONARY VESSELS

414.19 OTHER ANEURYSM OF HEART

414.4 CORONARY ATHEROSCLEROSIS DUE TO CALCIFIED CORONARY LESION

414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE

414.9 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED

423.1 ADHESIVE PERICARDITIS

423.2 CONSTRICTIVE PERICARDITIS

424.0 MITRAL VALVE DISORDERS

425.0 ENDOMYOCARDIAL FIBROSIS

425.11 HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY

425.18 OTHER HYPERTROPHIC CARDIOMYOPATHY

425.2 OBSCURE CARDIOMYOPATHY OF AFRICA

425.3 ENDOCARDIAL FIBROELASTOSIS

425.4 OTHER PRIMARY CARDIOMYOPATHIES

425.5 ALCOHOLIC CARDIOMYOPATHY

425.7 NUTRITIONAL AND METABOLIC CARDIOMYOPATHY

425.8 CARDIOMYOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE

425.9 SECONDARY CARDIOMYOPATHY UNSPECIFIED

426.0 ATRIOVENTRICULAR BLOCK COMPLETE

426.12 MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK

426.13 OTHER SECOND DEGREE ATRIOVENTRICULAR BLOCK

426.2 LEFT BUNDLE BRANCH HEMIBLOCK

426.4 RIGHT BUNDLE BRANCH BLOCK

426.53 OTHER BILATERAL BUNDLE BRANCH BLOCK

426.7 ANOMALOUS ATRIOVENTRICULAR EXCITATION

426.82 LONG QT SYNDROME

426.9 CONDUCTION DISORDER UNSPECIFIED

427.0 PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

427.1 PAROXYSMAL VENTRICULAR TACHYCARDIA

427.31 ATRIAL FIBRILLATION

427.32 ATRIAL FLUTTER

427.41 VENTRICULAR FIBRILLATION

427.42 VENTRICULAR FLUTTER

427.5 CARDIAC ARREST

427.61 SUPRAVENTRICULAR PREMATURE BEATS

427.69 OTHER PREMATURE BEATS

427.81 SINOATRIAL NODE DYSFUNCTION

427.89 OTHER SPECIFIED CARDIAC DYSRHYTHMIAS

427.9 CARDIAC DYSRHYTHMIA UNSPECIFIED

429.3 CARDIOMEGALY

429.4 FUNCTIONAL DISTURBANCES FOLLOWING CARDIAC SURGERY

429.9 HEART DISEASE UNSPECIFIED

780.2 SYNCOPE AND COLLAPSE

785.1 PALPITATIONS

E942.0* CARDIAC RHYTHM REGULATORS CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE

E942.1* CARDIOTONIC GLYCOSIDES AND DRUGS OF SIMILAR ACTION CAUSING ADVERSE EFFECTS IN THERAPEUTIC USE

V45.00* UNSPECIFIED CARDIAC DEVICE IN SITU

V45.01* CARDIAC PACEMAKER IN SITU

V45.02* AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR IN SITU

V45.09* OTHER SPECIFIED CARDIAC DEVICE IN SITU

V67.51 FOLLOW-UP EXAMINATION FOLLOWING COMPLETED TREATMENT WITH HIGH-RISK MEDICATION NOT ELSEWHERE CLASSIFIED

* According to the ICD-9-CM book, diagnosis codes E942.0, E942.1, V45.00, V45.01, V45.02 and V45.09 are secondary diagnosis codes and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

 

• Medical record documentation maintained by the ordering/referring physician must clearly indicate the medical necessity of holter monitor studies covered by the Medicare program.

o Also, the results of holter studies covered by the Medicare program must be included in the patient's medical record.

• If the provider of holter studies is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation along with copies of the ordering/referring physician's order for the study.

o When ordering holter studies from an independent physiological lab or other provider, the ordering/referring physician must state the reason for the holter study in his order for the test.

 

 

Utilization Guidelines

 

• It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.

• When services are performed in excess of established parameters, they may be subject to review for medical necessity.

 

 

Treatment Logic

 

• Electrocardiographic monitoring can be performed on ambulatory patients over a set period of time (usually twenty four hours).

• The monitoring device (holter monitor) allows the patient to resume their normal lifestyle and activities while recording episodes of arrhythmia.

• This gives the physician documented episodes of arrhythmias or absence of arrhythmias to correlate with the patient's symptoms.

 

 

Sources of Information and Basis for Decision

 

Abbott, A. (2005). Diagnostic Approach to Palpitations. American Family Physician 71(4).

 

Arend, W., Armitage, J., Drazen, J., Eds, et al (2004). Goldman: Cecil Textbook of Medicine, 22nd ed. W.B. Saunders Company.

 

Sivaskumaran, S., Krahn, A., et al (2003). A prospective randomized comparison of loop recorders versus Holter monitors in patients with syncope or presyncope. American Journal of Medicine 115 (1).

 

Zipes, D., Libby, P., et al (2005). Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier.

 

10/08/2012

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

 

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

Local Coverage Determination (LCD) External Electrocardiographic Recording (L29162)