CPT® Code 93235 | Case2Code

Code deleted. For external ECG see 93224-93227

Official Description

Wearable electrocardiographic rhythm derived monitoring for 24 hours by continuous computerized monitoring and non-continuous recording, and real-time data analysis utilizing a device capable of producing intermittent full-sized waveform tracings, possibly patient activated; includes monitoring and real-time data analysis with report, physician review and interpretation

Common Language Description

Wearable electrocardiographic rhythm-derived monitoring, as described by CPT® Code 93235, involves the collection of electrocardiographic (ECG) data over a continuous 24-hour period. This procedure is performed using a specialized device known as a Holter monitor, which the patient wears during their normal daily activities. The Holter monitor consists of electrodes or leads that are affixed to the patient's chest, allowing for the continuous recording of the heart's electrical activity. The device is designed to provide uninterrupted computerized monitoring of ECG signals throughout the day, capturing various heart rhythms and rates. During this monitoring period, the device analyzes the ECG data in real-time, identifying any abnormal rhythms that may occur. The patient may also have the option to activate the device manually if they experience symptoms, prompting the device to record and analyze the data at that moment. The Holter monitor generates intermittent full-sized waveform tracings or printouts of selected ECG rhythm strips based on the analysis of the recorded data. The information collected includes critical metrics such as heart rhythm and rate, ST segment analysis, heart rate variability, and T-wave alternans. After the monitoring period, a physician reviews and interprets the data to assess for potential heart arrhythmias. The comprehensive nature of this procedure, which encompasses monitoring, real-time data analysis, and physician interpretation, is encapsulated in the reporting of CPT® Code 93235. For cases where only monitoring and data analysis are performed without physician interpretation, CPT® Code 93236 is applicable, while CPT® Code 93237 is designated for instances where only the physician's review and interpretation of the data are reported.

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. This includes, but is not limited to, the following conditions:

Arrhythmia Evaluation Patients exhibiting symptoms of arrhythmias, such as palpitations, dizziness, or syncope, may require this monitoring to identify and characterize abnormal heart rhythms.
Assessment of Cardiac Symptoms Individuals presenting with unexplained chest pain or shortness of breath may benefit from this procedure to determine if these symptoms correlate with any arrhythmic events.
Post-Myocardial Infarction Monitoring Patients recovering from a heart attack may undergo this monitoring to evaluate for potential arrhythmias that could complicate their recovery.
Preoperative Assessment Prior to certain surgical procedures, this monitoring may be indicated to assess the cardiac rhythm and ensure the patient is stable.

2. Procedure

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

Step 1: Patient Preparation The patient is prepared for the procedure by having electrodes or leads placed on their chest. This setup is crucial for capturing the electrical signals generated by the heart. The patient is instructed on how to use the Holter monitor, including how to activate it if they experience any symptoms during the monitoring period.
Step 2: Device Application Once the electrodes are securely attached, the Holter monitor is affixed to the patient, allowing for continuous monitoring of the ECG signals. The device is designed to record data for a full 24 hours, capturing the heart's activity during the patient's normal daily routine.
Step 3: Continuous Monitoring Throughout the 24-hour period, the Holter monitor continuously records the ECG data. The device utilizes computerized algorithms to analyze the heart rhythms in real-time, flagging any abnormal rhythms that may occur. This feature allows for immediate data analysis and recording of significant events.
Step 4: Data Collection and Analysis The device produces intermittent full-sized waveform tracings or printouts of selected ECG rhythm strips based on the analysis of the recorded data. This includes detailed information on heart rhythm, rate, ST segment analysis, and other relevant metrics.
Step 5: Device Removal and Data Review After the 24-hour monitoring period, the device is removed from the patient. The recorded data is then reviewed and interpreted by a physician, who assesses the findings for any potential arrhythmias or other cardiac issues.

3. Post-Procedure

Post-procedure care involves the physician's review of the collected data, which is essential for diagnosing any arrhythmias or other cardiac conditions. The physician will generate a report summarizing the findings, which may include recommendations for further testing or treatment based on the results. Patients may be advised to follow up with their healthcare provider to discuss the results and any necessary next steps. It is important for patients to report any ongoing symptoms or concerns during this follow-up visit.

Short Descr	ECG MONITOR/REPORT, 24 HRS
Medium Descr	WR ECG 24 HR FULL-SIZE TRCG W/MNTR/A/PHYS R&I
Long Descr	WR ECG 24 HR FULL-SIZE TRCG W/MNTR/A/PHYS R&I
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	4 - Global Test 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
Type of Service (TOS)	5 - Diagnostic Laboratory
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	203 - Electrographic cardiac monitoring