In order to bill the professional service (-26) for remote interrogations, Medicare expects the physician
to personally perform the physician analysis, review and report. Additionally, if the physician is billing
only the remote technical service (93296 or 93299) Medicare assigns general supervision (01) in the
RBRVS fee schedule database, which is defined as “the procedure is furnished under the physician’s
overall direction and control, but the physician’s presence is not required during the performance of the
procedure. Under general supervision, the training of the non-physician personnel who actually
performs the diagnostic procedure and the maintenance of the necessary equipment and supplies are
the continuing responsibility of the physician.” Therefore, the physician’s staff must perform the
technical services under the general supervision of the physician, which includes data acquisition(s),
receipt of transmissions and technical review, technical support and distribution of results.
For Additional Information Please refer the February 2009 page 3 CPT Assistant Article: Excerpts are
Remote Interrogation Services for Implantable Cardiovascular Monitoring Systems and Implantable Loop Recorders: Codes 93297-93299
Previous codes did not allow for reporting of information obtained and reviewed by physicians from some of today's newest devices. These devices derive data either directly from the implanted device (most often an ICD) or from remote sensors in contact with the device. Physiologic monitoring reflecting evidence of volume overload through measurements of intrathoracic impedance, left atrial pressure, and/or blood pressure from sensors provide data separate from heart rhythm data. This technology required codes that clearly distinguish the unique services performed by physicians and, potentially, by electrophysiologists for their portion of data review, such as the physiologic data, that may be reviewed by a heart failure specialist. A review of physiologic data may allow providers to respond to hemodynamic changes prior to the onset of symptoms.
This category of codes offers three new codes, one specific to the physician component of remote interrogation of an implantable cardiovascular monitor's data (93297) and one for the physician component of remote interrogation of an implantable loop recorder (93298). There is a third code to represent the technical component of these codes (93299).
To assist the reader in distinguishing these services from other device interrogations, the following definitions were developed and are located in the introductory section of CPT.
•Implantable Cardiovascular Monitor (ICM): An implantable cardiovascular device used to assist the physician in the management of non-rhythm-related cardiac conditions, such as heart failure. The device collects longitudinal physiologic cardiovascular data elements from one or more internal sensors (such as right ventricular pressure, left atrial pressure, respiratory rate, or an index of lung water) and, when used, external sensors (such as blood pressure or body weight) for patient assessment and management. The data are stored and transmitted to the physician by either local telemetry or remotely to an Internetbased file server or surveillance technician. The function of the ICM may be an additional function of an implantable cardiac device (eg, a cardiac resynchronization therapy-defibrillator [CRT-D]) or a function of a stand-alone device. When ICM functionality is included in an ICD device, the ICM data and the ICD heart rhythm data, such as sensing, pacing, and tachycardia detection therapy, are distinct and, therefore, the monitoring processes are distinct.
•Implantable Loop Recorder (ILR): An implantable device that continuously records the electrocardiographic rhythm triggered automatically by rapid and slow heart rates or by the patient during a symptomatic episode. The ILR function may be the only function of the device or it may be part of a pacemaker or implantable cardioverter-defibrillator device. The data are stored and transmitted to the physician by either local telemetry or remotely to an Internetbased file server or surveillance technician.
The previous code for the evaluation of a loop recorder described only an in-person service. The new code now describes remote transmission because the technology now exists for a remote ILR system. There are codes in other categories of CPT for an ILR in-person programming evaluation (93285) and remote interrogation evaluation (93291). New code 93299 now reflects the technical work associated with a remote interrogation evaluation as a physician may elect to have an IDTF perform this service.
An important distinction to make with these remote interrogation codes is that these codes are to be reported only once per 30-day period, unlike other remote interrogation services which are reported once per 90-day period.
It is also important to note that many patients will have an ICD with the capabilities of collecting ICM data. This leads to the potential interaction between the codes for an in-person or remote device evaluation in the same period as an ICM evaluation.
There are parenthetical notes to clarify that the remote ICM interrogation code (93297) is not to be reported in conjunction with code 93290 for an in-person interrogation of an ICM, or with code 93298 for the remote interrogation of an ILR device. The parenthetical note following code 93298 should instruct the user not to report code ILR device code 93298 with code 33282, ILR implantation. However, the parenthetical note as shown in CPT 2009 erroneously excludes code 33282 from the note. This correction has been posted to the CPT Web site errata document.
There are also parenthetical notes for CPT code 93296, which represents the technical side of a remote ICD interrogation, stating that code 93296 is not to be reported in conjunction with code 93299 for the remote ICM data. This was necessary because an ICD may contain features of both the ICM and ILR device. Therefore, reporting both codes for the technical service would be duplication. In these situations, the most "sophisticated" device should be chosen for the technical monitoring code.
For the physician component of the remote interrogation of these combined devices, analysis of the ICD data would be reported using code 93295; for the physician's analysis of remote interrogation ICM data, code 93297 should be reported and could be reported in addition to the remote ICD evaluation. This is because the non-rhythm-derived elements were treated differently. It is not appropriate to report rhythm elements in this manner, that is, 93298 may not be reported with code 93294 or 93295. While crossreference parenthetical notes do not stipulate this, the introductory language does.
A service center may report code 93296 or 93299 when a physician performs an in-person interrogation device evaluation. A physician may not report an in-person and remote interrogation of the same device during the same period. Only report only remote services when an inperson interrogation device evaluation is performed during a period of remote interrogation device evaluation. A period is established by the initiation of the remote monitoring, or the 91st day of a pacemaker or implantable cardioverter defibrillator (ICD) monitoring, or the 31st day of an implantable loop recorder (ILR) or implantable cardiovascular monitor (ICM) monitoring, and extends for the subsequent 30 or 90 days, respectively, for which remote monitoring is occurring. Programming device evaluations and in-person interrogation device evaluations may not be reported on the same date by the same physician. Both programming device evaluations and remote interrogation device evaluations may be reported during the remote interrogation device evaluation period.