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Cardiac rehabilitation is a structured program that is professionally supervised, focusing on exercise and education to aid patients in their recovery from significant cardiac events such as heart attacks, open heart surgeries, or other coronary interventions like stenting or angioplasty. The program is designed to enhance the patient's physical fitness, alleviate cardiac symptoms, and improve overall health, thereby reducing the risk of future heart-related issues, including subsequent heart attacks. During the rehabilitation process, 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) is 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 includes counseling on various lifestyle modifications, such as dietary changes, smoking cessation, and stress management. It may also address psychological aspects, including support for 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 this critical monitoring component. Each session of cardiac rehabilitation is reported separately, reflecting the ongoing nature of the treatment process.
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The procedure is indicated for patients recovering from significant cardiac events or interventions. The following conditions warrant the use of outpatient cardiac rehabilitation services:
The outpatient cardiac rehabilitation procedure involves several key steps that ensure a comprehensive approach to patient recovery. Each session is structured to provide both physical and educational support.
After completing each session of outpatient cardiac rehabilitation, patients are typically advised to continue their prescribed exercise regimen at home, as well as to adhere to the lifestyle changes discussed during counseling. Regular follow-up appointments may be scheduled to monitor progress and make any necessary adjustments to the rehabilitation program. Patients are encouraged to maintain open communication with their healthcare providers regarding any concerns or symptoms that may arise during their recovery process. The overall goal is to ensure a safe and effective transition back to daily activities while minimizing the risk of future cardiac events.
| Short Descr | PHYS/QHP OP CAR RHAB W/ECG | Medium Descr | PHYS/QHP O/P CARDIAC RHAB W/CONT ECG MONITORING | Long Descr | Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with 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 |
| KX | Requirements specified in the medical policy have been met | 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. | CR | Catastrophe/disaster related | 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. | X2 | Continuous/focused services: for reporting services by clinicians whose expertise is needed for the ongoing management of a chronic disease or a condition that needs to be managed and followed with no planned endpoint to the relationship; reporting clinician service examples include but are not limited to: a rheumatologist taking care of the patient's rheumatoid arthritis longitudinally but not providing general primary care services | GZ | Item or service expected to be denied as not reasonable and necessary | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | FR | The supervising practitioner was present through two-way, audio/video communication technology | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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. |
| 2013-01-01 | Changed | Description Changed |
| 2011-01-01 | Changed | Medium description changed. |
| 1990-01-01 | Added | First appearance in code book in 1990. |
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