CPT® Code 93236 | 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; monitoring and real-time data analysis with report

Common Language Description

Wearable electrocardiographic rhythm-derived monitoring, as described by CPT® Code 93236, involves the collection of electrocardiographic (ECG) data over a continuous 24-hour period. This procedure is performed using a specialized device, commonly referred to as a Holter monitor, which the patient wears during their normal daily activities. The monitoring 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 receives instructions on how to use the monitoring device effectively. Throughout the day, the device continuously records ECG signals, allowing for comprehensive monitoring of the heart's rhythm and rate. The device is equipped with computerized technology that classifies various ECG waveforms and performs real-time data analysis. This analysis is crucial as it enables the device to flag any abnormal heart rhythms that may occur during the monitoring period. Additionally, the patient may have the option to activate the device manually if they experience symptoms, prompting the device to record and analyze the data at that specific moment. The Holter monitor produces intermittent full-sized waveform tracings or printouts of selected ECG rhythm strips based on the real-time analysis, providing valuable insights into the patient's cardiac health. The data collected includes critical information such as heart rhythm, heart rate, ST segment analysis, heart rate variability, and T-wave alternans. After the monitoring period, a physician reviews and interprets the recorded data to identify any potential heart arrhythmias. It is important to note that while CPT® Code 93236 covers the monitoring and real-time data analysis with a report, CPT® Code 93235 should be reported for the complete procedure, which includes the physician's review and interpretation of the data. Conversely, CPT® Code 93237 is designated for the physician's review and interpretation only, without the monitoring component.

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:

Evaluation of Arrhythmias Patients experiencing symptoms such as palpitations, dizziness, or syncope may require monitoring to identify potential arrhythmias.
Assessment of Cardiac Symptoms Individuals with unexplained chest pain or other cardiac-related symptoms may benefit from this monitoring to determine the underlying cause.
Post-Myocardial Infarction Monitoring Patients recovering from a heart attack may need continuous monitoring to assess heart function and rhythm stability.
Preoperative Assessment Patients undergoing certain surgical procedures may require rhythm monitoring to evaluate cardiac risk prior to surgery.

2. Procedure

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

Step 1: Patient Preparation The patient is prepared for the procedure by having electrodes or leads placed on their chest. This placement is crucial for capturing the electrical signals of the heart accurately. The healthcare provider ensures that the skin is clean and free of oils or lotions to enhance electrode adhesion and signal quality.
Step 2: Device Instruction The patient receives detailed instructions on how to use the Holter monitor. This includes guidance on wearing the device, how to activate it if they experience symptoms, and any activities to avoid during the monitoring period to ensure optimal data collection.
Step 3: Continuous Monitoring Once the device is secured, it begins continuous computerized monitoring of the ECG signals for a full 24 hours. The device records the heart's electrical activity throughout the patient's daily activities, allowing for a comprehensive assessment of heart rhythm and rate.
Step 4: Real-Time Data Analysis The monitoring device performs real-time data analysis, classifying different ECG waveforms. It flags any abnormal rhythms that occur during the monitoring period, providing immediate feedback on the patient's cardiac status.
Step 5: Data Recording The device produces intermittent full-sized waveform tracings or printouts of selected ECG rhythm strips based on the analysis. This recorded data is essential for the physician's review and interpretation.

3. Post-Procedure

After the 24-hour monitoring period, the patient returns the device to the healthcare provider for data analysis. The physician reviews the recorded data to interpret the findings, focusing on identifying any arrhythmias or other cardiac abnormalities. The results are compiled into a report, which includes the analysis of heart rhythm, heart rate, ST segment changes, and any other relevant findings. The physician may discuss the results with the patient and recommend further diagnostic testing or treatment options based on the findings. It is important for the patient to follow any post-procedure instructions provided by the healthcare provider to ensure proper follow-up care.

Short Descr	ECG MONITOR/REPORT, 24 HRS
Medium Descr	WR ECG 24 HR FULL-SIZE TRACG W/REPRT
Long Descr	WR ECG 24 HR FULL-SIZE TRACG W/REPRT
Status Code	Carriers Price the 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)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	203 - Electrographic cardiac monitoring