Cardiology Coding Alert
Cardiac Output
New Mexico Subscriber
Answer: Cardiac monitoring using electrical bioimpedance is a form of impedance plethysmography, which Dorlands Medical Dictionary defines as a technique for detecting blood volume changes by measuring changes in electrical resistance. Electrical bioimpedance allows for noninvasive cardiac monitoring and measurement of cardiac output, stroke volume, systemic vascular resistance and thoracic fluid content. CMS Transmittal No. 109, CR 824/827 (April 1999) modified Coverage Issues manual section 50-54 to allow coverage for cardiac monitoring using electrical bioimpedance in the following instances:
Noninvasive diagnosis or monitoring of hemodynamics in patients with suspected or known cardiovascular disease.
Differentiation of cardiogenic from pulmonary causes of acute dyspnea.
Optimization of atrioventricular (A/V) interval for patient with A/V sequential cardiac pacemakers.
Patients with need of determination for intravenous inotropic therapy.
Post-heart transplant myocardial biopsy patients.
Patients with a need for fluid management.
Furthermore, Part B carriers are permitted to cover other uses for bioimpedance devices when there is sufficient evidence of their medical effectiveness.
The devices are specifically not covered for monitoring patients with proven or suspected disease involving severe regurgitation of the aorta or minute ventilation sensor function pacemakers, which may be affected by the monitoring device.
The CIM also notes that these monitoring devices do not render accurate measurements in cardiac bypass patients while on a cardiopulmonary bypass machine, but do provide accurate measurements prior to and post bypass pump.
Use 93701 (Bioimpedance, thoracic, electrical) to report this service to Medicare carriers and private payers that cover the service.
You Be the Coder and Reader Questions were answered by Sueanne Bicknell, RHIA, CCS-P, CPC, director of compliance with Cardiology and Internal Medicine Associates in Dallas; Gay Boughton-Barnes, CPC, MPC, CCS-P, a cardiology coding and reimbursement specialist in Tulsa, Okla.; Susan Callaway, CPC, CCS-P, a coding and reimbursement specialist and educator in North Augusta, S.C.; Sandy Rubio, RN, CPC, a cardiology coding and reimbursement specialist in Omaha, Neb.; Kathleen Mueller, RN, CPC, CCS-P, a cardiology coding and reimbursement specialist in Lenzburg, Ill.; Savannah Siens, CPC, CCS-P, a cardiology coding and reimbursement specialist in Kansas City, Mo.; Nikki Vendegna, CPC, a cardiology coding and reimbursement specialist in Overland Park, Kan.; and Marko Yakovlevitch, MD, FACP, FACC, a cardiologist in private practice in Seattle.
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