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Hint: Some devices record continuously, but some need to be activated.

Patients who may have an irregular heartbeat present in all kinds of ways: some experience frequent symptoms, others have symptoms sporadically, and others may never experience any. The unpredictability makes it challenging for providers trying to detect and accurately diagnose an arrhythmia. Devices such as Holter monitors help narrow down a diagnosis. Cardiovascular monitoring devices can be worn by the patient and record electrocardiographic (ECG) data for days or weeks at a time.

As with symptomology, these devices aren’t one-size-fits-all. A wide variety of devices exist that allow monitoring to be tailored to each patient’s unique needs. That also means there are a wide variety of code choices — and yes, it can get complicated!

This month, find out the basics about three kinds of wearable cardiovascular devices, and look for more information next month on some technical aspects of coding these devices.

Define Holter Monitors

Holter monitors are capable of recording continuously for up to 48 hours. Electrodes are placed on the chest and wired to a recording device. The device is small and is usually worn on the patient’s belt or placed in a pouch that can be worn around the neck. Some newer devices may not have electrodes or wires. Instead, the device is a small patch that is placed on the chest.

Data from Holter monitors is stored on an internal chip. Some devices have patient-activated event monitor features that document when the patient is experiencing symptoms so the provider can correlate them with certain activities or any arrhythmias recorded on the ECG. After removal, the scanned data on the chip is analyzed by a technologist using software before being interpreted by a physician.

Holter monitor services are reported with codes 93224 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional) through 93227 (External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional).

Long-term continuous monitors function like Holter monitors but are capable of longer recording periods. Some record and store data for greater than 48 hours up to seven days while others record for greater than seven days up to 15 days. Long-term continuous monitoring services are reported with codes 93241 (External electrocardiographic recording for more than 48 hours up to 7 days by continuous rhythm recording and storage; includes recording, scanning analysis with report, review and interpretation) through 93248 (External electrocardiographic recording for more than 7 days up to 15 days by continuous rhythm recording and storage; review and interpretation).

See What Distinguishes MCT Devices

Mobile cardiac telemetry (MCT) devices have a continuous recording capacity of up to 30 days. For MCT, electrodes are placed on the chest. They may be connected to a transmitter with a lead or transmit via Bluetooth connection, and data is transmitted to an attended surveillance center. CPT^® guidelines define attended surveillance as having the immediate availability of a remote technician to respond to rhythm or device alert transmissions.

The tracings can be transmitted at any time and are viewed in real-time as events occur. MCT devices have internal ECG analysis algorithms. These algorithms are designed to detect major arrythmias that trigger data to be sent to the surveillance center. Transmissions may also be patient-activated when experiencing symptoms. The complete recording is analyzed at the end of the recording period for arrhythmias that may not have been detected with the algorithms or correlated with symptoms.

Mobile cardiac telemetry services are reported with codes 93228 (External mobile cardiovascular telemetry with electrocardiographic 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; review and interpretation with report by a physician or other qualified health care professional) and 93229 (External mobile cardiovascular telemetry with electrocardiographic 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; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional).

Event monitors record segments of ECGs after activation — they do not record continuously. There are several mechanisms of activation. Patients may activate them when symptoms are felt or the device may be activated with internal preprogrammed detection algorithms. Some monitors require that electrodes be attached to the chest and connected to the transmitter. Others may be a watch. Some devices are handheld and are placed on the chest to record the heart’s rhythm when symptoms are noticed.

Data is transmitted upon request to an attended surveillance center. Event monitor services are reported with codes 93268 (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, review and interpretation by a physician or other qualified health care professional) through 93272 (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; review and interpretation by a physician or other qualified health care professional).

Look for more information on how to code wearables perfectly in next month’s RCI.

Brittany Sowards, BA, CPC, CPMC, CCC, CCVTC, Clinical Documentation Specialist