Referring to Medicare’s NCD and LCD from Your MAC Can Help You Comply.
Once a pacemaker is inserted, the patient needs continuing monitoring to ensure the pacemaker is functioning properly. However, during consultation, issues arise and one is unable to meet the frequency guidelines for telephonic monitoring. Here’s a primer on how to improve your understanding of the guidelines, which medical procedure codes to report, whether performance and reporting frequency match, and more.
Transtelephonic Monitoring: Look to NCDs & LCDs for More Cue on the Guidelines
As per cardiac device evaluation services guidelines, CPT® has a definition of transtelephonic rhythm strip pacemaker evaluation. A good way to complying with telephonic monitoring frequency guidelines is by referring to Medicare’s NCD. Another way to improve your understanding is by checking for an LCD from your MAC. You can even search for Medicare policies in the Medicare Coverage Database on the CMS website. Moreover, you can use the database to look up NCDs and LCDs.
CMS Covers Transtelephonic PM Monitoring – Here’s Why
As per NCD guidelines, Medicare covers telephone monitoring of pacemakers since the service assists in lowering risk of sudden failure by recognizing failure’s early signs. Monitoring systems can discover subclinical failure due to a drained battery. What’s more, some monitoring systems can detect additional issues including internal electronic problems.
Performance and Reporting Frequency – Do They Match?
For transtelephonic pacemaker monitoring, you’ll use 93293. Underneath this code is an instruction to report 93293 only once per 90 days. This supports the element towards the end of the code’s descriptor.
As per NCDs, MACs need to combine frequency guidelines it provides with knowledge of local medical practices to screen monitoring claims. The patient’s condition, for example, may justify more frequent monitoring. The onus is on the practice, therefore, to ensure it meets the frequency guidelines by keeping a track of these services in the EMR.
In a Nutshell: CMS guidelines point to a general rule for the number of times monitoring is medically required. Having said that, it does not indicate you should report each service separately. Use CPT®code 93293 once every 90 days that you provide a monitoring service, irrespective of whether you provide one service or more.
Heed This Too: When you look up CPT procedure code 93293, you’ll find that Medicare Physician Fee Schedule divides the code into separate professional and technical components. However, if your practice provides only the provider’s review and report, ensure you apply modifier 26 (PC). The monitoring facility will report the TC.