CPT 93224, 93225, 93228 , 93229 - ECG monitoring WEM

Long-term wearable electrocardiographic monitoring (WEM) is a diagnostic procedure that provides a record of the heart rhythm during daily activities. This procedure can often identify the existence and determine the frequency of clinically significant rhythm disturbances and waveform abnormalities that are missed on a standard electrocardiogram (ECG).

Non-Activated Continuous Recorders (holter monitor/external electrocardiographic recording) (CPT codes 93224 – 93227) provide a continuous record of heart rhythm during a 48 hour period. This procedure can often identify the existence of ECG rhythm derived elements that are missed on a standard ECG.

This service is appropriate when arrhythmias are known or suspected to occur at least once in 48 hours 

Patient/Event-Activated Intermittent Recorders (loop event monitors, remote cardiovascular monitoring) (CPT codes 93228, 93229, and 93268 - 93272) are indicated when symptoms are sporadic to establish whether or not they are caused by transient arrhythmias. 

This service is an appropriate alternative to 48 hour monitoring in patients who experience infrequent symptoms (less frequently than every 48 hours) suggestive of cardiac arrhythmias (i.e., palpitations, dizziness, presyncope or syncope) or when a 48 hour service is not diagnostic.

Indications

The covered indications are:

To detect, characterize and document symptomatic transient arrhythmias.

To aid in regulating anti-arrhythmic drug dosage.

To aid in the search for the cause of unexplained syncope, dizziness or giddiness.

To monitor patients who have had surgical or ablative procedures for arrhythmias, since post ablation atrial fibrillation can be asymptomatic.

To aid in the search for the cause of TIA/CVA.

Limitations

A WEM service is medically unnecessary if it offers little or no potential for new clinical data beyond that which has been obtained from a previous test or if other tests are better suited to obtain the clinical data relevant to the patient’s condition. 

A test may be ordered only by a physician or other qualified health care professional treating the beneficiary.

WEMs are not covered for outpatient monitoring of recently discharged postinfarct patients.

When the billing of these services is split into components, it is expected that the appropriate components of the code series will be billed. 

For 30-day WEM service: 

WEM may be discontinued once the symptom-producing arrhythmia has been documented and diagnosed or following multiple transmissions during symptoms, without arrhythmia. It is unlikely that the arrhythmias would always be diagnosed on the first day of recording or that the service would always last only one day. The average duration of monitoring is anticipated to last 10–14 days or more.

WEM is a 30-day packaged service. Tests may not be billed more than once within 30 days of each other, even if the earlier of the tests was discontinued when arrhythmias were documented and the patient is now reconnected for follow-up of therapy or intervention.

Because the WEM service requires the diagnosis and evaluation of intermittent arrhythmias and patients must be continuously attached to presymptom loop recorders, each patient is required to have a recorder for his/her own exclusive use throughout the duration of the monitoring period. 

The receiving station must be staffed on a 24-hour basis. An answering service/answering machine would not fulfill this requirement.

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

999xNot Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999Not Applicable

G45.1 - G45.2 - Opens in a new windowCarotid artery syndrome (hemispheric) - Multiple and bilateral precerebral artery syndromes

G45.8 - G46.2 - Opens in a new windowOther transient cerebral ischemic attacks and related syndromes - Posterior cerebral 

artery syndrome

I20.0 - I20.9 - Opens in a new windowUnstable angina - Angina pectoris, unspecified

I24.0 - I24.9 - Opens in a new windowAcute coronary thrombosis not resulting in myocardial infarction - Acute ischemic 

heart disease, unspecified

I25.110 - I25.2 - Opens in a new windowAtherosclerotic heart disease of native coronary artery with unstable angina pectoris 

- Old myocardial infarction

I25.5 - I25.799 - Opens in a new windowIschemic cardiomyopathy - Atherosclerosis of other coronary artery bypass graft(s) 

with unspecified angina pectoris

I25.89 - I25.9 - Opens in a new windowOther forms of chronic ischemic heart disease - Chronic ischemic heart disease, 

unspecified

I34.0 - I35.9 - Opens in a new windowNonrheumatic mitral (valve) insufficiency - Nonrheumatic aortic valve disorder, 

unspecified

I42.0Dilated cardiomyopathy

I42.5Other restrictive cardiomyopathy

I42.8 - I42.9 - Opens in a new windowOther cardiomyopathies - Cardiomyopathy, unspecified

I44.1 - I44.30 - Opens in a new windowAtrioventricular block, second degree - Unspecified atrioventricular block

I44.4 - I45.2 - Opens in a new windowLeft anterior fascicular block - Bifascicular block

I45.5 - I45.9 - Opens in a new windowOther specified heart block - Conduction disorder, unspecified

I47.0 - I48.92 - Opens in a new windowRe-entry ventricular arrhythmia - Unspecified atrial flutter

I49.02 - I50.9 - Opens in a new windowVentricular flutter - Heart failure, unspecified

I63.40 - I63.49 - Opens in a new windowCerebral infarction due to embolism of unspecified cerebral artery - Cerebral 

infarction due to embolism of other cerebral artery

I66.01 - I66.3 - Opens in a new windowOcclusion and stenosis of right middle cerebral artery - Occlusion and stenosis of 

cerebellar arteries

I66.9Occlusion and stenosis of unspecified cerebral artery

I67.841 - I67.848 - Opens in a new windowReversible cerebrovascular vasoconstriction syndrome - Other cerebrovascular 

vasospasm and vasoconstriction

R00.0 - R00.2 - Opens in a new windowTachycardia, unspecified - Palpitations

R06.00 - R06.01 - Opens in a new windowDyspnea, unspecified - Orthopnea

R06.09Other forms of dyspnea

R06.89Other abnormalities of breathing

R07.2Precordial pain

R07.82 - R07.9 - Opens in a new windowIntercostal pain - Chest pain, unspecified

R40.4Transient alteration of awareness

R42Dizziness and giddiness

R55Syncope and collapse

T82.110A - T82.111S - Opens in a new windowBreakdown (mechanical) of cardiac electrode, initial encounter - Breakdown 

(mechanical) of cardiac pulse generator (battery), sequela

T82.120A - T82.121S - Opens in a new windowDisplacement of cardiac electrode, initial encounter - Displacement of 

cardiac pulse generator (battery), sequela

T82.190A - T82.191S - Opens in a new windowOther mechanical complication of cardiac electrode, initial encounter - Other 

mechanical complication of cardiac pulse generator (battery), sequela

Z09Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

Z51.81Encounter for therapeutic drug level monitoring

Z79.02 - Z79.1 - Opens in a new windowLong term (current) use of antithrombotics/antiplatelets - Long term (current) use of 

non-steroidal anti-inflammatories (NSAID)

Z79.899Other long term (current) drug therapy

Z95.0Presence of cardiac pacemaker

Z95.9Presence of cardiac and vascular implant and graft, unspecified