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HealthNow UMD
Article -- Coding Guidelines
Contractor Name
HealthNow
Contractor Number
00801
Contractor Type
Carrier
Article Database ID Number
A27725
Contractor Determination Number
CV003G04
Article Type
Article
Article Title
Ambulatory Electrocardiographic Monitoring - 3
Is the AMA CPT / ADA CDT Copyright Statement Required?
Yes
CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. CDT-4 codes and descriptions are (C) 2002, 2004 American Dental Association. All rights reserved.
Primary Geographic Jurisdiction
Upstate New York
Article Start Date
04/08/2005
Article Revision Effective Date
05/19/2008
Article Ending Effective Date
N/A
Coding Guidelines
1. The guidelines of the Correct Coding Initiative (CCI) supersede all
coding instructions in this LCD.
2. The diagnosis code(s) must best describe the patient's condition for
which the service was performed.
3. Use CPT procedure codes 93224 through 93227 (first family of codes) if
the service is a full 24-hour recording and playback utilizes "visual
superimposition scanning."
4. Use CPT procedure codes 93230 through 93233 (second family of codes)
if the service is a full 24-hour recording and is displayed with full,
miniaturized printout but without superimposition scanning.
5. Use CPT procedure codes 93235 through 93237 (third family of codes) to
report the use of real time (solid state) devices.
6. "TC" or "26" modifiers are not appropriate and should not be used with
any of these codes.
7. A rhythm strip (CPT procedure codes 93040-93042) is not reimbursable
when performed on the same day as a Holter monitor set-up (Correct
Coding Initiative [CCI]).
8. For monitoring extending beyond 24 hours, the number of services
should be listed as "1" and the date of the service is the date of the
hook-up.
9. The name and UPIN number of the referring/ordering physician or
qualified non-physician practitioner must be reported in Items 17 and
17a of the CMS-1500 form, or NPI (when effective) in item 17b, or in
the electronic equivalent, when submitting electronically.
10. When the physician interpreting the test is billing as part of a
group, the 6-digit PIN or NPI (when effective) of the provider
interpreting the test must be identified on the CMS-1500 form in Item
24J or in the electronic equivalent, when submitting electronically.
11. Use ICD-9-CM diagnosis code V82.9 (Special screening for other
conditions, unspecified condition) when reporting a Holter monitor
code in the absence of signs, symptoms or complaints. This will lead
to an automatic coverage denial.
12. When the technical portion of the diagnostic test is purchased, place
a check in the "yes" box on line 20 of the CMS-1500 form and enter the
supplier's cost for the test in the "$charges" field on the same line.
Report the name, address (including the zip code) and provider number
or NPI (when effective) of the supplier of the test in Item 32 of the
CMS-1500 form.
13. The only payable places of service for the global procedures (93224,
93230, and 93235) are office (11) and independent clinic (49).
14. The only payable places of service for technical component only codes
(93226, 93232, and 93236) are office (11) and independent clinic (49).
Codes 93225 and 93231 are payable in office (11), home (12), group
home (14), independent clinic (49).
15. Payable places of service for the professional component only codes
(93227, 93233, and 93237) are office (11), inpatient hospital (21),
outpatient hospital (22), emergency room (23) and independent clinic
(49).
16. Independent diagnostic testing facilities (IDTFs) should bill the
global procedure (93224, 93230, or 93235) only if the physician
interpreting the test is an employee of the facility, is not billing
for the interpretation separately, and all components of the service
have been provided at the facility. When the global procedure does not
apply, IDTFs should bill the applicable component CPT code(s)
(93225-93227, 93231-93233, 93235-93237) with the appropriate place of
service for each component to the carrier in whose jurisdiction the
service was rendered.
Example: If an IDTF hooks up a patient at the patient's home in
Carrier A territory, scans the tape at the IDTF facility in Carrier B
territory, and then sends all reports for review and interpretation to
a physician working for them in Carrier C territory, each service with
the applicable place of service (POS) code must be billed separately
to the appropriate carrier.
17. Codes 93225 and 93231 will be payable in nursing facilities/assisted
living facilities (places of service 13, 31, 32, and 33) for Part B
residents only, as well as in office (11), home (12), group home
foster care setting for children and adolescents in state custody(14)
and independent clinic (49).
18. IDTFs performing these services to Part B residents in a skilled
nursing facility (SNF) should report place of service (31).
Coverage Topic
Diagnostic Tests and X-rays
CPT/HCPCS Codes
93224 Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage, with visual superimposition scanning; includes recording, scanning analysis with report, physician review and interpretation
93225 ; recording (includes hook-up, recording, and disconnection)
93226 ; scanning analysis with report
93227 ; physician review and interpretation
93230 Electrocardiographic monitoring for 24 hours by continuous original ECG waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; includes recording, microprocessor-based analysis with report, physician review and interpretation
93231 ; recording (includes hook-up, recording, and disconnection)
93232 ; microprocessor-based analysis with report
93233 ; physician review and interpretation
93235 Electrocardiographic monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; includes monitoring and real-time data analysis with report, physician review and interpretation
93236 ; monitoring and real-time data analysis with report
93237 ; physician review and interpretation
Other Comments
For services that exceed the accepted standard of medical practice and may
be deemed not medically necessary, the provider/supplier should provide
the patient with an acceptable advance notice of Medicare's possible
denial of payment. An advance beneficiary notice (ABN) should be signed
when a provider/supplier does not want to accept financial responsibility
for the service.
Revision History
Revision #3: Revised guideline 10 to change item 24k to 24J per MLN Matters SE0529.
Revision #2: Revised guidelines 9, 10 and 11 to include information about NPI.
Revision #1: Added place of service 13 and 14 as payable. Added Coding Guideline #2.
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