© Copyright 2025 American Medical Association. All rights reserved.
External electrocardiographic recording, identified by CPT® Code 93226, involves the continuous monitoring of a patient's heart rhythm for a duration of up to 48 hours. This procedure utilizes an external electrocardiogram (ECG) device, commonly referred to as a Holter monitor, which is worn by the patient during their normal daily activities. The process begins with the placement of electrodes or leads on the patient's chest, allowing for the capture of the heart's electrical activity. The Holter monitor records this activity continuously, generating original ECG waveforms that are stored on a magnetic tape or a digital medium for subsequent analysis. The data collected during this monitoring period includes critical information such as heart rhythm, heart rate, ST segment analysis, heart rate variability, and T-wave alternans. After the monitoring period concludes, the patient returns the device to the healthcare provider, where the stored data undergoes a detailed scanning analysis. This analysis involves visual superimposition scanning, which provides a comprehensive overview of the entire recording, enabling the identification of various ECG waveforms and selective rhythm strip samples. A report is generated following this analysis, which is then reviewed and interpreted by a physician or qualified healthcare professional to assess for any heart arrhythmias. It is important to note that this code specifically pertains to the analysis of the scanning with report, distinguishing it from other related codes that cover different aspects of the procedure.
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External electrocardiographic recording (CPT® Code 93226) is indicated for the assessment of various cardiac conditions and symptoms that may require monitoring of the heart's electrical activity over an extended period. The following are the explicitly provided indications for this procedure:
The procedure for external electrocardiographic recording using CPT® Code 93226 involves several key steps that ensure accurate monitoring and data collection. The following procedural steps are outlined:
Following the external electrocardiographic recording, the patient may be provided with instructions regarding any necessary follow-up care or additional testing based on the results of the analysis. The physician will review the report generated from the scanning analysis and discuss the findings with the patient, which may include recommendations for further evaluation or treatment if any arrhythmias or abnormalities are detected. The expected recovery from this procedure is typically immediate, as it is non-invasive and does not require any downtime. Patients are encouraged to resume their normal activities after the device is removed, unless otherwise instructed by their healthcare provider.
| Short Descr | XTRNL ECG REC<48 HR SCAN A/R | Medium Descr | XTRNL ECG REC<48 HRS SCANNING A/R | Long Descr | External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report | 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 |
| GZ | Item or service expected to be denied as not reasonable and necessary | 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). | QD | Recording and storage in solid state memory by a digital recorder | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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). | 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. | 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2025-01-01 | Changed | Short and Medium Descriptions 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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