Documentation supporting medical necessity is vital for ensuring proper reimbursement. Include the following recommended documentation components to support the claim:
- Patient’s relevant signs and symptoms and pertinent medical history
- Frequency of symptom occurrence, intermittent symptoms that occur less frequently than every 48 hours may be an indication for long term monitoring
- Prior test results (particularly previous inconclusive cardiac monitoring tests)
- Expectations on improved diagnostic implication using long term monitoring
- The expected level of patient compliance with long-term ECG monitoring
Disclaimer: This information is provided only as a guide and is not intended to replace any official recommendations or guidelines, and does not constitute advice or a promise or guarantee by Warriors Medical regarding coverage or payment. Always check with the patient’s insurance plan for the appropriate use of any CPT procedure or ICD-10-CM diagnosis.
ICD-10-CM Diagnosis Codes
Extended Holter Monitors are indicated for use in detecting arrhythmia in a wide range of diagnosis, it is important to document the indicators for Long Term Cardiac Monitoring (greater than 48 hours) rather than a regular 24-48-hour Holter, common reasons include a non-diagnostic Holter and infrequent symptoms unlikely to be detected on a 24-48-hour scan.
The following is a list of commonly use ICS-10-CM codes that may assist you in documenting Medical necessity. This is not an exhaustive list of all available codes, and it is possible that there are more appropriate codes for any given diagnosis or symptom. Include all appropriate ICD-10 diagnosis codes and supporting clinical documentation when submitting claims.
Please Note: it is important that you check the Local Coverage Determination from your local Medicare Administrative Contractor as well as your Payors for covered ICD-10 codes as well as other specific requirements and policy updates.