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Official Description

External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 93225 refers to the procedure of external electrocardiographic recording, which is conducted for a duration of up to 48 hours. This procedure involves continuous rhythm recording and storage of the heart's electrical activity while the patient engages in their normal daily activities. The device used for this monitoring is commonly known as a Holter monitor. During the procedure, electrodes or leads are affixed to the patient's chest, allowing for the collection of electrocardiographic (ECG) data. The patient is provided with instructions on how to properly use the monitor throughout the monitoring period. The Holter monitor continuously records the ECG waveforms, capturing the heart's rhythm and rate, as well as other important metrics such as ST segment analysis, heart rate variability, and T-wave alternans. The data collected is stored on a magnetic tape or a digitized medium for subsequent analysis. After the monitoring period concludes, the patient returns the device to the healthcare provider, where the recorded data is reviewed. A visual superimposition scanning technique is employed to create a comprehensive overview of the entire recording, allowing for the identification of various ECG waveforms and the extraction of selective rhythm strip samples. Following this analysis, a report is generated, which is then reviewed and interpreted by a physician or qualified healthcare professional to assess for any potential heart arrhythmias. It is important to note that while CPT® Code 93225 covers the recording aspect of the procedure, including the connection, recording, and disconnection of the device, other related codes such as 93224, 93226, and 93227 are designated for the complete procedure, analysis, and interpretation of the data, respectively.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The external electrocardiographic recording using CPT® Code 93225 is indicated for patients who require monitoring of their heart's electrical activity over an extended period. This procedure is typically performed in the following scenarios:

  • Assessment of Arrhythmias Patients exhibiting symptoms such as palpitations, dizziness, or syncope may require this monitoring to identify potential arrhythmias that may not be captured during a standard ECG.
  • Evaluation of Cardiac Symptoms Individuals presenting with unexplained chest pain or other cardiac-related symptoms may benefit from continuous monitoring to correlate symptoms with heart activity.
  • Post-Myocardial Infarction Monitoring Patients recovering from a heart attack may be monitored to assess heart rhythm stability and detect any arrhythmias that could pose a risk during recovery.
  • Preoperative Assessment Patients undergoing certain surgical procedures may require monitoring to evaluate cardiac function and rhythm prior to surgery.

2. Procedure

The procedure associated with CPT® Code 93225 involves several key steps to ensure accurate and effective monitoring of the patient's heart activity. The following outlines the procedural steps:

  • Step 1: Patient Preparation The patient is prepared for the procedure by explaining the purpose and process of the Holter monitor. The healthcare provider ensures that the patient understands how to wear the device and the importance of maintaining a normal daily routine during the monitoring period.
  • Step 2: Electrode Placement Electrodes or leads are carefully placed on the patient's chest. This placement is crucial for capturing accurate ECG readings, and the provider ensures that the electrodes adhere properly to the skin to prevent dislodgment during the monitoring period.
  • Step 3: Device Connection The Holter monitor is connected to the electrodes, and the device is activated to begin recording. The patient is instructed on how to operate the device, including any buttons to press if they experience symptoms that should be noted.
  • Step 4: Continuous Monitoring The device records the heart's electrical activity continuously for a period ranging from 12 to 48 hours. During this time, the patient goes about their daily activities, allowing for a comprehensive assessment of heart rhythm under normal conditions.
  • Step 5: Device Disconnection At the end of the monitoring period, the patient returns to the healthcare facility, where the device is disconnected. The recorded data is then stored for analysis.

3. Post-Procedure

After the external electrocardiographic recording is completed, the patient may be advised to resume normal activities unless otherwise instructed. The healthcare provider will analyze the stored data, which includes a comprehensive review of the heart's electrical activity during the monitoring period. A report is generated based on this analysis, detailing any identified arrhythmias or abnormalities. The physician or qualified healthcare professional will then review and interpret the findings, discussing the results with the patient and determining any necessary follow-up actions or treatments based on the recorded data.

Short Descr XTRNL ECG REC<48 HRS REC
Medium Descr XTRNL ECG REC<48 HRS RECORDING
Long Descr External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection)
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 3 - Technical Component Only Code
Multiple Procedures (51) 6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services apply...
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 01 - Procedure must be performed under the general supervision of a physician.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator STV-Packaged Codes
Type of Service (TOS) 5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS) T2C - Other tests - EKG monitoring
MUE 1
CCS Clinical Classification 203 - Electrographic cardiac monitoring
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
52 Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
QD Recording and storage in solid state memory by a digital recorder
GA Waiver of liability statement issued as required by payer policy, individual case
GZ Item or service expected to be denied as not reasonable and necessary
CR Catastrophe/disaster related
25 Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59.
53 Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
95 Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
CC Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
GW Service not related to the hospice patient's terminal condition
KX Requirements specified in the medical policy have been met
LT Left side (used to identify procedures performed on the left side of the body)
PD Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
PO Excepted service provided at an off-campus, outpatient, provider-based department of a hospital
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
QT Recording and storage on tape by an analog tape recorder
SA Nurse practitioner rendering service in collaboration with a physician
TC Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
Date
Action
Notes
2025-01-01 Changed Short and Medium Descriptions changed.
2013-01-01 Changed Medium Descriptor changed.
2011-04-04 Changed Practice Expense RVU changed
2011-01-01 Changed Long description revised. Medium description changed. Short description changed. Location in hierarchy changed.
2009-01-01 Changed Code description changed
1990-01-01 Added First appearance in code book in 1990.
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