In the evolving landscape of cardiac care, remote monitoring of implantable devices has become an indispensable tool for proactive patient management.
A clear understanding of the billing and reimbursement guidelines is paramount for cardiologists leveraging this technology. The billing specialists at MediBillMD designed this guide to navigate the complexities surrounding CPT code 93297.
It will delve into the essentials of compliant and accurate billing, ensuring you can confidently integrate this vital service into your practice while optimizing your revenue cycle.
So, without further ado, let’s explore the critical details related to this CPT code.
CPT Code 93297 – Description
CPT code 93297 is from the ‘Implantable, Insertable, and Wearable Cardiac Device Evaluations’ code range. It is maintained by the American Medical Association (AMA). It covers the evaluation of the physiological data from the implantable physiologic cardiovascular monitoring system. The physician evaluates the data over a period of 30 days via telemetric communication from external and internal sensors.
Scenarios Where CPT Code 93297 is Applicable
Let’s review some clinical scenarios to understand where CPT 93297 applies:
Post-ICD Implantation Arrhythmia Monitoring
Picture this: A 50-year-old female patient with a history of ventricular tachycardia recently had an implantable cardioverter-defibrillator (ICD) placed in her chest.
Over the next 30 days, the provider remotely monitors heart rate, rhythm, and any detected ventricular arrhythmias transmitted from the ICD.
The physician reviews the telemetric data and notes non-sustained ventricular tachycardia that fails to meet the threshold for ICD therapy. Additionally, the physician adjusts the anti-arrhythmic medication during a follow-up telehealth visit within this 30-day monitoring window.
Here, CPT code 93297 applies.
Intermittent Remote Checks for Pacemaker Function Assessment
Consider this: A 70-year-old female patient with a dual-chamber pacemaker implanted for sick sinus syndrome undergoes routine remote monitoring checks every few weeks as part of her long-term pacemaker function management.
The physician reviews the telemetrically transmitted data and assesses the pacemaker’s battery status, lead impedance, and the frequency of ventricular and atrial pacing.
Additionally, the physician schedules the patient for an in-office visit based on the findings to ensure proactive pacemaker management.
Later, he reports CPT code 93297 to bill for the services.
Post-Cardiac Transplant Monitoring with Implantable Physiologic Sensor
Imagine this: A 55-year-old male patient recently underwent a heart transplant. He has an implanted physiologic cardiovascular monitoring system. It tracks his heart rate, activity, and potential intrathoracic impedance.
The transplant cardiology team remotely monitors these parameters to detect early signs of rejection or infection for the first 30 days after the transplant.
The physician reviews the transmitted data. It reveals a slight upsurge in resting heart rate, with a decline in activity levels. Therefore, the physician orders further diagnostic tests to rule out subclinical rejection.
Here, CPT code 93297 applies.
Applicable Modifiers for CPT Code 93297
Do you want to ensure coding accuracy? If yes, understanding the appropriate use of modifiers is essential. Here’s a list of a few applicable modifiers for CPT 93297:
Modifier 26
Append modifier 26 when you want to bill for the professional component of CPT code 93297. This modifier indicates that the physician is only billing the interpretation of the collected data from internal and external sensors.
Modifier TC
Contrary to modifier 26, you append modifier TC to bill for the technical component of CPT code 93297. It represents that you are billing for the equipment use and involvement of technical staff in the remote monitoring of the physiological data.
Modifier 59
Modifier 59 applies when the service covered under CPT 93297 is distinct and eligible for a separate reimbursement from other services rendered on the same day. Appending this modifier is integral to avoid unnecessary bundling of services.
Modifier 76
It represents that the same physician repeats the service. Therefore, you should append modifier 76 when the physician repeats the physiologic cardiovascular monitoring within a short timeframe.
Modifier 77
Append modifier 77 to the CPT code 93297 when a different physician repeats the physiologic cardiovascular monitoring within a short timeframe.
CPT Code 93297 – Billing & Reimbursement Guidelines
Discussed below are the billing and reimbursement guidelines related to the evaluation of the data from the implantable physiologic cardiovascular monitoring system:
Ensure Accurate Billing of CPT Code 93297
It is a global procedure that involves both the technical and professional components of remote monitoring of physiological parameters. The provider monitors these parameters from an implantable cardiovascular device with a report for up to 30 days. You can report it once every 30 days.
If you are wondering who can bill it? A physician or other qualified healthcare professional can report it for the remote interrogation services covered under CPT code 93297. However, reimbursement hinges upon establishing the medical necessity of the service. Your documentation must clearly state the patient’s symptoms, diagnoses, and any other indication supporting the medical necessity of the remote interrogation.
Append the Appropriate Modifier for Remote Monitoring
Correct modifier usage enables coding specificity and billing accuracy for CPT code 93297. It covers both the technical and professional components of remote monitoring. Therefore, if you want to bill a single component, you must append a relevant modifier.
For instance, when you submit the claim with modifier 26, it indicates that the physician is billing only for the interpretation and report preparation of the remote monitoring of the physiological data. Conversely, CPT 93297 with modifier TC identifies that a separate entity is billing for the technical component, i.e., device supervision and data transmission.
Some other modifiers that may apply to this procedural code are 59, 76, and 77. You can check the ‘Applicable Modifiers for CPT Code 93297’ section of the guide for more details on the appropriate modifier usage.
Understand the Specific Payer Policies
Reimbursement policies for CPT code 93297 can vary significantly among private payers and Medicare. Since Medicare is a government entity, it follows standard reimbursement and billing guidelines.
You can review the Medicare Physician Fee Schedule (MPFS) to determine the payment rate. However, the rate may vary across different states of the US. Thus, we recommend you consult the Local Coverage Determinations (LCDs) issued by their specific Medicare Administrative Contractor (MAC). LCDs have the most accurate and up-to-date coverage and billing rules within its jurisdiction.
If you talk about private payers, different payers may set their own rules and policies. Therefore, communicate with the payer before submitting claims.
Additionally, you should verify insurance eligibility and acquire prior authorization before rendering services, regardless of the payer.
Summary
Alright, that was a lot of ground to cover! Let’s consolidate those insights with a rapid-fire summary of the must-knows.
First came the descriptor. CPT code 93297 covers the remote evaluation of an implantable cardiovascular physiologic monitoring system.
Second, we shared the clinical scenarios: post-cardiac transplant monitoring with implantable physiologic sensors and intermittent remote checks for pacemaker function assessment.
Next, we shared a detailed list of a few applicable modifiers, including 26, TC, 59, 76, and 77.
Finally, we explained the billing and reimbursement requirements for reporting CPT code 93297.This guide will likely become your go-to resource for revenue cycle enhancement. However, if you need specialized cardiology billing services, consider MediBillMD.
