2010 Cardiac Device Evaluation Code Look-Up

1. CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restriction Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.
2. Medicare Physician 2010 national payment rate information can be found at  http://www.cms.hhs.gov/PhysicianFeeSched/

Additional Coding Information:
Medtronic has prepared this document to reflect the applicable cardiac device monitoring services since their implementation on January 1, 2009. It is important to refer to the CPT code descriptions in order to ensure that a billed code meets the specific requirements defined for each individual code. You should contact your local Medicare contractor/payer for interpretation of applicable policies.

The monitoring period described by these codes include an in person, 30-day, or a 90-day monitoring period. Remote monitoring codes have separate CPT codes for the professional and technical components.

For CPT codes other than for remote monitoring, the Global CPT codes comprise the Professional and Technical Components. If both components of care are rendered, it is not necessary to append a modifier to the code. However, the remote monitoring codes are an example of a global service that requires two different CPT codes to be billed together, as one code represents the Professional Service and another code represents the Technical Service (e.g., CPT 93294 & 93296, 93295 & 93296, 93297 & 93299, and 93298 & 93299).

The Professional Component reflects physician time and intensity in furnishing the service, including activities before and after direct patient contact.¹ When only the professional component is performed, modifier -26 should be added to the appropriate CPT code to identify the service. The -26 modifier would not be appended if the code represents only the professional services of the CPT code description (e.g., CPT 93294, 93295, 93297, and 93298).

The Technical Component refers to the resources used in furnishing the service, such as office rent, wages of personnel, and other office practice expenses. When only the technical component is performed, the modifier -TC² should be added to the appropriate CPT code to identify the service. The -TC modifier would not be appended if the code represents only the technical support and services component of the CPT code description (e.g., CPT 93296, and 93299).

Physician Supervision Requirements
Medicare established specific diagnostic test supervision requirements applicable to the technical component of the electronic analysis of implanted cardiac devices. These supervision requirements are in addition to any other Medicare coverage requirements. The Medicare supervision requirements for individual CPT codes are available on the Physician Fee Schedule Lookup function on the Medicare website³ or under “PFS Relative Value Files” for 2010.⁴
Medicare requires:

• General supervision of the technical component for all remote interrogation services and  transtelephonic pacemaker monitoring (codes 93296, 93299, and 93293)
• Direct supervision of the technical component for all in person cardiac device interrogations

Medicare has also indicated that the specific supervision requirements for device monitoring of implanted cardiac devices are inapplicable where the physician is eligible to bill a global CPT code, a CPT code with a professional component modifier (-26) or a specific code that represents the professional component (93294, 93295, 93297 and 93298) for their analysis.^3,5

General supervision⁵ means the procedure is furnished under the physician’s overall direction and control, but the physician’s presence is not required during the performance of the procedure. Under general supervision, the training of the non-physician personnel who actually performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician.

Direct supervision⁵ means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed.

The Heart Rhythm Society (HRS) released a document which represents their consensus statement on the role of manufacturers’ representatives in the care of patients with heart rhythm disorders. This policy statement also contains HRS’ perspective on appropriate delivery of and billing for the technical component of services associated with cardiac devices.⁶ We encourage providers to seek confirmation or clarification from the payer about the policy statement.

These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff. The ultimate responsibility for correct coding lies with the provider of services. Please contact your local payer for interpretation of the appropriate codes to use for specific procedures. Medtronic make no guarantee that the use of this information will prevent differences of opinion or disputes with Medicare or other third part payers as to the correct form of billing or the amount that will be paid to providers of service.

For questions or for more information, please contact Medtronic 1 (866) 877-4102, option 1.

Cardiac Rhythm Disease Management (CRDM) reimbursement customer information is available at www.medtronic.com.crdmreimbursement.

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1. Social Security Act Section 1848(c) (1) (A) and (B).
2. Section 410.32(b) of the Code of Federal Regulations (CFR).
3. Medicare’s website is: http://www.cms.hhs.gov/PfsLookup/
4. http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp#TopOfPage, file PPRRVU10.
5. The Medicare Benefit Policy Manual, CMS-Pub. 100-02 Chapter 15, §80 - Covered Medical and Other Health Services indicates that the “concept does not apply.” This Policy Manual can be found at http://www.cms.hhs.gov/Manuals/IOM/list.asp
6. Lindsay BD, Estes NA III, Maloney JD, Reynolds DW. Heart Rhythm Society Policy Statement Update: Recommendations on the Role of Industry Employed Allied Professionals (IEAPs). Heart Rhythm. November 2008;5(11):e8-10. This document can be found at: http://www.hrsonline.org/Policy/ClinicalGuidelines/updated_ieaps.cfm