Review of Ambulatory ECG Reimbursement (CPT) Codes
Our neighbor to the north, Canada, and, more specifically, the province of Ontario, is sometimes significantly further along than the United States. For example, they realize the efficacy of using long-term Holter — that is, more than 48 hours — as the preferred diagnostic for the preponderance of cases. Sure, there is a small fraction of the patient population that may need near-real-time monitoring, but those cases should, at a minimum, be carefully justified as the cost of that infrastructure is dramatically greater than simple Holter.
In historical order, from oldest to newest technology, there are four Current Procedural Terminology (CPT®) codes, developed by the American Medical Association, for ambulatory ECG measurements. CPT is identified by the Centers for Medicare and Medicaid Services as Level 1 of the Healthcare Common Procedure Coding System.
The Global codes are listed below, along with their descriptions. Global means that the codes include these three elements, which are sometimes performed and billed by different entities:
- Professional component — includes hookup, recording, and disconnection
- Technical component — includes transmission, analysis, and report
- Physician component — includes review and interpretation
93268: Ambulatory Cardiac Event
External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, physician review and interpretation
93224: 24-48 Hour Holter
External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, physician review and interpretation
0295T: Long-Term Holter
External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; includes recording
(includes connection and initial recording) (Effective 01.01.2012)
93228/93229: External Mobile Cardiovascular Telemetry Services
Commonly called MCT/MCOT. External mobile cardiovascular telemetry with electrocardiograph recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage — retrievable with query — with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days;
- CPT code 93228 is the professional component of this service and includes review and interpretation of each 24-hour cardiac surveillance as well as 24-hour availability and response to monitoring events within a course of treatment that includes up to 30 consecutive days of cardiac monitoring.
- CPT code 93229 is the technical component of this service and includes all of the following within a course of treatment that includes up to 30 consecutive days of cardiac monitoring:
- Patient hook-up and patient-specific instruction and education
- Transmission and receipt of ECG
- Analysis of ECG by nonphysician personnel
- Medical chart documentation including daily report, patient and/or physician interaction and response, and summary report at the end of the monitoring episode
- Equipment maintenance.
- All supplies necessary for completion of the monitoring
Although this information is primarily centered on payments and reimbursements for ambulatory ECG diagnostics, it may still shed some light on where the collective thinking is headed and is a clear indication that, in the U.S., the perception of the value of longer-term Holter is on the rise.
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