Are you in charge of monitoring cardiac devices remotely? You must understand its different codes! Around 20% of large healthcare facilities may have adopted RPM solutions, but billing continues to pose a challenge for many. Healthcare providers, including cardiology physicians and technicians, struggle to assign the correct codes to every service and procedure.
But trust us! With the right knowledge, you can overcome anything. CPT code 93296 is one of the codes you should know for billing remote cardiac evaluations. Specifically, it refers to the technical part of the monitoring. Let us explain how you can use this code accurately!
CPT Code 93296 – Description
As mentioned earlier, CPT code 93296 refers to the technical aspect of remote cardiac monitoring. To be more specific, it describes the remote observation of a pacemaker (single, dual, multiple lead, or leadless) or an implantable cardioverter-defibrillator (ICD) system — a small battery-powered device placed in a patient’s chest.
Still confused? Let us simplify this code further! Technicians usually use CPT code 93296 when collecting data from the patient’s implanted device for up to 90 days. They achieve this by remotely accessing the device. After retrieving information, they conduct a technical review and forward the results to the patient’s healthcare provider, usually a cardiologist.
In short, CPT code 93296 only covers data acquisition from the pacemaker over 90 days and technical support. It does not include a physician’s analysis or interpretation.
Scenarios Where CPT Code 93296 is Applicable
Let’s discuss three specific scenarios where CPT code 93296 is applicable. These real-world examples will help you understand this code better.
Monitoring Dual-Chamber Pacemaker
Here is a simple scenario! Suppose a 68-year-old man with a third-degree atrioventricular block (complete heart block) has a six-year-old dual-chamber pacemaker implanted in his chest. This device has two leads (one attached to the atrium and the other to the ventricle) to help manage the patient’s condition by mimicking the heart’s natural rhythm.
A technician remotely observes the device for any changes in performance. He records and retrieves data over 90 days, evaluating:
- Atrial and ventricular pacing rates
- Battery status
- Any irregular heartbeats.
After collecting sufficient information, he conducts a technical analysis and sends the data to the cardiologist for interpretation. The billing team then bills for this technical monitoring using CPT code 93296.
Observing Single-Lead Pacemaker
Did you know sinus bradycardia is the most common type of bradycardia, affecting 1 in every 1,000 people? So, for our next example, let’s consider a 66-year-old woman with this condition (slower-than-normal heartbeats, < 60 bpm, due to malfunctioning of the sinoatrial node). She has a single-lead pacemaker implanted to manage her condition.
The pacemaker provides electrical impulses to simulate the sinoatrial node’s function, helping regulate the heart rate. The technician remotely accesses the device every 90 days, retrieving data to check the pacemaker’s:
- Pacing threshold
- Battery status
- Lead integrity
He then performs a technical review and sends the report to the healthcare provider for further evaluation. The billing team reports this remote technical service using CPT code 93296.
Monitoring an Implantable Cardioverter Defibrillator (ICD)
Now, let’s envision a scenario involving an implantable cardioverter defibrillator (ICD)! Suppose a 71-year-old man with life-threatening arrhythmia (ventricular tachycardia) gets an ICD implant instead of a regular pacemaker. The primary purpose of this device is to prevent cardiac arrest, as the patient is at high risk.
The ICD sends large shocks to correct abnormal heart rates. A cardiology technician remotely monitors this device over 90 days, collecting data on:
- Battery health
- Arrhythmic events
- Overall device performance
After the technical review, the technician sends the results to the cardiologist for interpretation. The billing team reports the technician’s services using CPT code 93296.
CPT Code 93296 – Billing & Reimbursement Guidelines
Billing for remote pacemaker monitoring can be quite simple, especially with the right guidance. Follow these simple tips to use CPT code 93296 accurately.
Verify Insurance Coverage
Before billing for remote pacemaker monitoring, we advise reviewing the patient’s insurance policy to verify coverage. Medicare generally covers remote observation of cardiac pacemakers.
However, Medicaid and other private insurers’ coverage may vary significantly from state to state. Therefore, always verify your patient’s eligibility before remotely accessing their pacemaker device to retrieve information.
Use CPT Code 93296 Correctly
Keep in mind that this code only covers the technical part of cardiac pacemaker monitoring. Therefore, use it only to report the technician’s role, and don’t confuse it with CPT code 93297 (physician analysis).
Understand the Billing Frequency
Understanding billing frequency is one of the most important things about CPT code 93296. Many professionals face claim denials because they report this code multiple times a month. Remember, according to CMS, you can only bill this code once every 90 days for a patient under remote monitoring, that is, 4 times per year.
Other payers may have different frequency limitations. Therefore, always confirm with the insurance company whether they allow multiple claims for this code.
Properly Document the Remote Data Collection & Review Process
The technical part of remote pacemaker monitoring should be well-documented to support the use of CPT code 93296. Make sure to record the following details:
- Monitoring period (up to 90 days)
- Device type (single, dual, multiple lead, leadless pacemaker, or ICD)
- Details of remote access (date and summary of technical review)
- Potential issues identified during data collection and technical analysis (e.g., battery depletion, lead displacement, device malfunction)
Summary
Confusing guidelines and documentation issues may have previously hindered your payments. However, with our guide, you can now sail through your billing, at least for remote cardiac pacemaker monitoring.
Let’s do a quick recap! CPT code 93296 refers to the technical part of cardiac rhythm device evaluation. In simple words, remote monitoring of pacemakers or ICDs! Cardiology technicians mostly use this code to receive payments for retrieving device information and performing technical reviews. In addition to the simple explanation, we have also tried to clear up your confusion about this code with three specific applicable scenarios and billing and reimbursement tips. But if coding still feels like an unsolvable puzzle, you can always opt for professional guidance. Our cardiology billing services include coding for cardiac device evaluations.
