© Copyright 2025 American Medical Association. All rights reserved.
Cardiac rehabilitation is a structured program that is professionally supervised, focusing on exercise and education to aid individuals recovering from significant cardiac events such as heart attacks, open heart surgeries, or other coronary interventions like stenting or angioplasty. The primary goal of this rehabilitation process is to enhance the patient's physical fitness, alleviate cardiac symptoms, and improve overall health, thereby reducing the risk of future cardiovascular issues, including subsequent heart attacks. During the rehabilitation sessions, a qualified healthcare professional conducts a thorough medical evaluation to assess the patient's specific needs and limitations. Based on this assessment, a tailored rehabilitation program is developed, which typically includes supervised physical activities such as treadmill exercises or cycling on an exercise bike. Throughout these activities, the patient's heart rate and blood pressure are closely monitored, and continuous electrocardiography (ECG) may be utilized as necessary to ensure safety and effectiveness. Patients are educated on how to monitor their heart rates and adjust their activity levels accordingly. Additionally, the program encompasses counseling on various lifestyle modifications, including dietary changes, smoking cessation, and stress management techniques. It may also address psychological aspects such as depression or anger management. For billing purposes, the CPT® code 93797 is used for outpatient cardiac rehabilitation sessions that do not involve continuous ECG monitoring, while 93798 is designated for sessions that include continuous ECG monitoring. Each session of cardiac rehabilitation is reported separately, emphasizing the individualized nature of the care provided.
© Copyright 2025 Coding Ahead. All rights reserved.
The outpatient cardiac rehabilitation program is indicated for patients recovering from various cardiac events and procedures. These include:
The procedure for outpatient cardiac rehabilitation without continuous ECG monitoring involves several key steps, which are outlined below:
After completing each session of outpatient cardiac rehabilitation, patients are typically advised to continue their prescribed exercise regimen at home, incorporating the skills and knowledge gained during the sessions. Follow-up appointments may be scheduled to monitor progress and make any necessary adjustments to the rehabilitation program. Patients are encouraged to maintain a healthy lifestyle, including regular physical activity, a balanced diet, and ongoing counseling support to further reduce the risk of future cardiac events. It is essential for patients to adhere to the recommendations provided by their healthcare professionals to optimize recovery and long-term health outcomes.
| Short Descr | PHYS/QHP OP CAR RHAB WO ECG | Medium Descr | PHYS/QHP O/P CARDIAC RHAB W/O CONT ECG MONITOR | Long Descr | Physician or other qualified health care professional services for outpatient cardiac rehabilitation; without continuous ECG monitoring (per session) | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service 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 | 09 - Concept does not apply. | 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 | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 5 - Diagnostic Laboratory | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 2 | CCS Clinical Classification | 215 - Other physical therapy and rehabilitation |
| 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. | 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. | KX | Requirements specified in the medical policy have been met | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | CA | Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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 | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2025-01-01 | Changed | Short and Medium Descriptions changed. |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| 1990-01-01 | Added | First appearance in code book in 1990. |
Get instant expert-level medical coding assistance.