How To Use CPT Code 93798

CPT 93798 refers to physician or other qualified healthcare professional services for outpatient cardiac rehabilitation with continuous ECG monitoring per session. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 93798.

1. What is CPT 93798?

CPT 93798 is a medical billing code used to describe the services provided by a physician or other qualified healthcare professional during outpatient cardiac rehabilitation. These services include supervising the patient’s exercise and reviewing their diet, with continuous electrocardiogram (ECG) monitoring throughout the session. The code is billed per session and is essential for accurate reimbursement and documentation of the services provided.

2. 93798 CPT code description

The official description of CPT code 93798 is: “Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)”.

3. Procedure

The 93798 procedure involves the following steps:

1. The patient arrives at the outpatient cardiac rehabilitation facility.
2. The physician or other qualified healthcare professional reviews the patient’s medical history and current condition.
3. The patient’s exercise program is designed based on their individual needs and goals.
4. Continuous ECG monitoring equipment is set up and attached to the patient.
5. The patient begins their exercise session under the supervision of the healthcare professional.
6. The healthcare professional monitors the patient’s ECG readings and makes any necessary adjustments to the exercise program.
7. The patient’s diet is reviewed and discussed with the healthcare professional.
8. Once the session is complete, the ECG monitoring equipment is removed, and the patient is discharged.

4. Qualifying circumstances

Patients eligible to receive CPT code 93798 services are those who have been diagnosed with a cardiac condition that requires outpatient cardiac rehabilitation. These conditions may include, but are not limited to, myocardial infarction, coronary artery bypass surgery, stable angina, heart valve repair or replacement, heart transplant, or heart failure. The patient’s physician must determine that cardiac rehabilitation is medically necessary and provide a referral for the program.

5. When to use CPT code 93798

It is appropriate to bill the 93798 CPT code when a physician or other qualified healthcare professional provides services for outpatient cardiac rehabilitation with continuous ECG monitoring. This code should be used for each session of cardiac rehabilitation that includes continuous ECG monitoring. It is essential to ensure that the patient meets the qualifying circumstances and that the services provided are medically necessary and documented appropriately.

6. Documentation requirements

To support a claim for CPT 93798, the following information should be documented:

• Patient’s medical history and current cardiac condition
• Physician’s referral for outpatient cardiac rehabilitation
• Individualized exercise program and goals
• Continuous ECG monitoring setup and readings
• Supervision by the healthcare professional during the session
• Dietary review and recommendations
• Duration of the session
• Any adjustments made to the exercise program based on ECG readings

7. Billing guidelines

When billing for CPT code 93798, it is essential to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips for billing this code include:

• Bill the code per session, not per hour or per day.
• Ensure that the patient meets the qualifying circumstances for outpatient cardiac rehabilitation.
• Document all necessary information to support the claim, as outlined in the documentation requirements section.
• Be aware of any payer-specific guidelines or requirements for billing CPT 93798.

8. Historical information

CPT 93798 was added to the Current Procedural Terminology system on January 1, 1990. The code’s description was changed on January 1, 2013, from “Physician services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session)” to its current description.

9. Similar codes to CPT 93798

Five similar codes to CPT 93798 and how they differ are:

• CPT 93797: This code is used for physician or other qualified healthcare professional services for outpatient cardiac rehabilitation without continuous ECG monitoring.
• CPT 93015: This code is for cardiovascular stress tests using maximal or submaximal treadmill or bicycle exercise, with continuous ECG monitoring and physician supervision.
• CPT 93016: This code is for physician supervision only during a cardiovascular stress test with continuous ECG monitoring.
• CPT 93018: This code is for the interpretation and report of a cardiovascular stress test with continuous ECG monitoring.
• CPT 93224: This code is for external electrocardiographic recording for up to 48 hours by continuous rhythm monitoring and storage.

10. Examples

Here are 10 detailed examples of CPT code 93798 procedures:

1. A patient with a recent myocardial infarction begins outpatient cardiac rehabilitation with continuous ECG monitoring to assess their exercise tolerance and response.
2. A patient who has undergone coronary artery bypass surgery participates in a supervised exercise session with continuous ECG monitoring to ensure their safety and monitor their progress.
3. A patient with stable angina attends a cardiac rehabilitation session with continuous ECG monitoring to evaluate the effectiveness of their medications and exercise program.
4. A patient who has had a heart valve replacement participates in an outpatient cardiac rehabilitation session with continuous ECG monitoring to assess their functional capacity and monitor for any arrhythmias.
5. A heart transplant recipient attends a cardiac rehabilitation session with continuous ECG monitoring to evaluate their exercise tolerance and monitor for any signs of rejection.
6. A patient with heart failure participates in a supervised exercise session with continuous ECG monitoring to assess their response to therapy and monitor for any worsening of their condition.
7. A patient with a history of ventricular arrhythmias attends a cardiac rehabilitation session with continuous ECG monitoring to ensure their safety during exercise and monitor for any recurrence of arrhythmias.
8. A patient who has undergone percutaneous coronary intervention participates in an outpatient cardiac rehabilitation session with continuous ECG monitoring to assess their functional capacity and monitor for any complications.
9. A patient with a history of syncope during exercise attends a cardiac rehabilitation session with continuous ECG monitoring to evaluate their exercise tolerance and monitor for any arrhythmias or other causes of syncope.
10. A patient with a pacemaker participates in a supervised exercise session with continuous ECG monitoring to assess their response to exercise and monitor for any issues with their pacemaker function.