CPT® Code 93231 | Case2Code

Code deleted. For external ECG see 93224-93227

Official Description

Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous original waveform recording and storage without superimposition scanning utilizing a device capable of producing a full miniaturized printout; recording (includes connection, recording, and disconnection)

Common Language Description

Wearable electrocardiographic rhythm-derived monitoring, as described by CPT® Code 93231, involves the continuous recording of the heart's electrical activity over a 24-hour period. This procedure utilizes a specialized 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, which are essential for capturing the electrical signals generated by the heart. The patient is then instructed on how to use the monitoring device effectively. Throughout the monitoring period, the device records original electrocardiographic (ECG) waveforms continuously, ensuring that a comprehensive dataset is collected. This data is typically stored on a magnetic tape or a digitized medium, allowing for later analysis. Upon completion of the monitoring period, the patient returns the device, and the stored data, which includes critical information such as heart rhythm, heart rate, ST segment analysis, heart rate variability, and T-wave alternans, is retrieved for evaluation. A miniaturized printout of the entire recording is generated, accompanied by a microprocessor-based analysis report that includes selective sampling of rhythm strips. This detailed information is crucial for physicians to review and interpret potential heart arrhythmias. It is important to note that while CPT® Code 93231 covers the recording aspect of the procedure, including the connection, recording, and disconnection of the device, other related codes exist for the complete procedure, microprocessor-based analysis, and physician interpretation, which should be reported separately as needed.

1. Indications

The wearable electrocardiographic rhythm-derived monitoring procedure is indicated for various clinical scenarios where continuous assessment of the heart's electrical activity is necessary. The following conditions may warrant the use of this monitoring technique:

Arrhythmia Evaluation Patients experiencing symptoms such as palpitations, dizziness, or syncope may require monitoring to identify potential arrhythmias.
Assessment of Heart Rate Variability This procedure can be utilized to evaluate heart rate variability, which may provide insights into autonomic nervous system function.
ST Segment Analysis Patients with known or suspected ischemic heart disease may need ST segment analysis to monitor for changes that could indicate myocardial ischemia.
T-Wave Alternans This monitoring can help assess T-wave alternans, which may be associated with an increased risk of arrhythmias.

2. Procedure

The procedure for wearable electrocardiographic rhythm-derived monitoring involves several key steps to ensure accurate data collection and analysis. The following steps outline the process:

Step 1: Patient Preparation The patient is prepared for the procedure by having electrodes or leads placed on their chest. This step is crucial as it establishes the connection necessary for recording the heart's electrical activity.
Step 2: Device Connection Once the electrodes are in place, the monitoring device, or Holter monitor, is connected to the electrodes. The patient is instructed on how to wear the device and any necessary precautions to take during the monitoring period.
Step 3: Continuous Recording The device begins continuous recording of the ECG waveforms as the patient goes about their daily activities. This recording lasts for a full 24 hours, capturing a comprehensive dataset of the heart's electrical activity.
Step 4: Device Disconnection After the 24-hour monitoring period, the patient returns to the healthcare facility to have the device disconnected. This step concludes the data collection phase of the procedure.
Step 5: Data Retrieval and Analysis The recorded data is retrieved from the device, which includes the original ECG waveforms. A miniaturized printout is generated, and a microprocessor-based analysis report is prepared for further evaluation.

3. Post-Procedure

After the procedure, the patient may be advised on any specific post-monitoring care, although no extensive recovery is typically required. The physician will review the collected data, which includes the continuous ECG recordings, to interpret the results for any arrhythmias or other cardiac conditions. The patient may be scheduled for a follow-up appointment to discuss the findings and any necessary further evaluations or treatments based on the results of the monitoring.

Short Descr	ECG MONITOR/RECORD, 24 HRS
Medium Descr	WR ECG 24 HR W/O SUPIMPOS W/MINI TRACG W/REC
Long Descr	WR ECG 24 HR W/O SUPIMPOS W/MINI TRACG W/REC
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)	0 - No payment adjustment rules for multiple procedures 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	Ancillary Services
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	T2C - Other tests - EKG monitoring
MUE	Not applicable/unspecified.
CCS Clinical Classification	203 - Electrographic cardiac monitoring