Cardiology Coding Alert

Question: The descriptor of 93268 mentions "attended monitoring." What does that mean exactly?

Florida Subscriber

Answer: The code you are referring to is event monitoring code 93268 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; includes transmission, review and interpretation by a physician or other qualified health care professional).

According to 93268's descriptor, this code requires "24-hour attended monitoring." The CPT^® guidelines define attended surveillance as "the immediate availability of a remote technician to respond to rhythm or device alert transmissions from a patient, either from an implanted or wearable monitoring or therapy device, as they are generated and transmitted to the remote surveillance location or center."

Event monitors defined: The event monitor codes span from 93268 to 93272 (External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attended monitoring; review and interpretation by a physician or other qualified health care professional). Event monitors record segments of ECGs activated by either the patient's symptoms or by an internal automatic, pre-programmed detection algorithm - or both. The devices "then transmit the recorded electrocardiographic data when requested (but cannot transmit immediately based upon the patient or algorithmic activation rhythm)," according to the CPT^® guidelines.

Unlike Holter monitors, cardiac event recorders capture relatively short segments of heart rhythm.

Bonus tip: All of these event monitor codes are telemedicine codes. In the CPT^® manual, Appendix P lists the codes you can use to report synchronous (real-time) telemedicine services. CPT^® identifies the appropriate telemedicine codes with a star (★) symbol next to the code in the code set.